Judith Gebauer1, Katja Baust2, Edit Bardi3,4, Desiree Grabow5, Alexander Stein6, Helena J van der Pal7, Gabriele Calaminus2, Thorsten Langer8. 1. Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. 2. Pediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany. 3. Department of Pediatrics and Adolescent Medicine, Kepler University Hospital, Linz, Austria. 4. St Anna Kinderspital, Vienna, Austria. 5. German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. 6. Hubertus Wald Tumor Centre, University Cancer Centre Hamburg, and Second Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 7. Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands. 8. Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany, Thorsten.Langer@uksh.de.
Abstract
BACKGROUND: Many childhood cancer survivors develop treatment-associated late effects emerging years or even decades after the end of treatment. Evidence-based guidelines recommend risk-adapted screening, facilitating early diagnosis and management of these sequelae. Long-term follow-up (LTFU) in specialized late effects clinics is devised to implement screening recommendations in the care of childhood cancer survivors. OBJECTIVES: To create a practical LTFU tool for the daily practice. METHODS: Current guidelines and screening recommendations concerning LTFU in adult survivors of childhood cancer were reviewed and a comprehensive LTFU approach was developed. RESULTS: A risk stratification model assigning patients to three risk groups with different screening recommendations and frequencies is presented based on current LTFU guidelines. Furthermore, a model of LTFU in a clinical multidisciplinary team is proposed. CONCLUSIONS: Although late morbidity and mortality in childhood cancer survivors have been attenuated in the last decade by reducing treatment toxicities, a high proportion of long-term survivors already is or will still be affected by treatment-associated chronic health conditions. With the knowledge of late effects and their occurrence as a consequence of specific treatment modalities, practical LTFU recommendations are essential to achieve standardized and structured LTFU care.
BACKGROUND: Many childhood cancer survivors develop treatment-associated late effects emerging years or even decades after the end of treatment. Evidence-based guidelines recommend risk-adapted screening, facilitating early diagnosis and management of these sequelae. Long-term follow-up (LTFU) in specialized late effects clinics is devised to implement screening recommendations in the care of childhood cancer survivors. OBJECTIVES: To create a practical LTFU tool for the daily practice. METHODS: Current guidelines and screening recommendations concerning LTFU in adult survivors of childhood cancer were reviewed and a comprehensive LTFU approach was developed. RESULTS: A risk stratification model assigning patients to three risk groups with different screening recommendations and frequencies is presented based on current LTFU guidelines. Furthermore, a model of LTFU in a clinical multidisciplinary team is proposed. CONCLUSIONS: Although late morbidity and mortality in childhood cancer survivors have been attenuated in the last decade by reducing treatment toxicities, a high proportion of long-term survivors already is or will still be affected by treatment-associated chronic health conditions. With the knowledge of late effects and their occurrence as a consequence of specific treatment modalities, practical LTFU recommendations are essential to achieve standardized and structured LTFU care.
Authors: E Aleshchenko; E Swart; C Spix; M Voigt; P Trocchi; T Langer; G Calaminus; K Baust; J Glogner; P Ihle; J Küpper-Nybelen; C Lüpkes; T Kloppe; D Horenkamp-Sonntag; I Meier; U Marschall; P Dröge; M Klein; A Weiss; C Apfelbacher Journal: BMC Health Serv Res Date: 2022-09-20 Impact factor: 2.908