Article Figures & Data
Tables
- Table 1.
Pediatric cooperative groupa strategies for development, implementation, dissemination, and maintenance of health screening guidelines for childhood cancer survivors
Establish aims and goals of guidelines ▪ Provide guidance to clinicians caring for survivors. ▪ Standardize and enhance follow-up care of survivors. ▪ Facilitate early identification of late treatment effects. ▪ Promote timely intervention for late treatment effects. ▪ Educate survivors and families about health risks. ▪ Promote healthy lifestyle of survivors. Define target population for screening ▪ By age at diagnosis (childhood, adolescent, young adult, and adult). ▪ By time from completion of therapy (≥2 years, ≥5 years, etc…). ▪ By disease status (maintained remission, stable disease, etc…). Consider intended users of guidelines ▪ Hematology/oncology providers (pediatric/medical, surgical, radiation, nursing, etc…). ▪ Primary care providers (pediatricians, family physicians, internist, and gynecologists). ▪ Subspecialty providers (pediatric/medical, endocrine, cardiology, etc…). ▪ Cancer survivors and families. Identify expertise required to develop the guidelines ▪ Hematology/oncology (pediatric/medical, surgery, radiation, nursing, and transplant). ▪ Primary care (pediatrics, family medicine, internal medicine, and gynecology). ▪ Subspecialty (pediatric/medical, endocrine, cardiology, etc…). ▪ Behavioral (psychology, social work). ▪ Supportive care (physical/occupational therapy, etc…). ▪ Patient/survivorship advocacy. ▪ Analytical (epidemiology, biostatistics, and public health services). Adopt guideline methodology ▪ Systematic review of evidence with assessment of methodologic quality of studies. ▪ Translation of evidence and clinical experience into screening recommendations. Determine preferred guideline design ▪ Therapy/exposure based ▪ Outcome based (by organ, tissue, or function) ▪ Disease based Establish guideline content ▪ Address both medical and psychosocial outcomes. ▪ Comprehensive versus selected key late effects. ▪ Organization/venue of long-term follow-up care. ▪ Provider versus survivor (patient education) format. ▪ Treatment summary template. ▪ Medical citations to support recommendations. Implement and disseminate guidelines ▪ Posting on internet website. ▪ Presentations at cooperative group and professional society meetings. ▪ Presentations in academic and community forums. ▪ Publication of review manuscripts. ▪ Incorporation into primary care pathways. ▪ Collaboration with health care and insurance organizations. Organize plan to maintain currency of guidelines ▪ Ongoing monitoring of late effects literature. ▪ Biennial systematic review by multidisciplinary task forces. ▪ Consideration of guideline revisions by oversight committee. ▪ International collaboration to harmonize recommendations. -
↵aGuidelines from the following Pediatric Cooperative Groups were reviewed for inclusion in this summary: Children's Oncology Group (COG; ref. 25), Children's Cancer and Leukemia Group (CCLG; ref. 23), Dutch Childhood Oncology Group (DCOG; ref. 26), and Scottish Intercollegiate Guidelines Network (SIGN; ref. 24).
-
- Table 2.
Levels of long-term follow-up carea for childhood cancer survivors
Risk of late effects Proposed levels of follow-up care Low ▪ Postal or telephone follow-up every 1 to 2 years. Surgery only; low-risk chemotherapy (excluding alkylators, anthracyclines, bleomycin, and epipodophyllotoxins) ▪ Single visit with cancer center long-term follow-up program followed by ongoing monitoring by primary care provider, according to follow-up plan established by cancer center. Moderate ▪ Follow-up every 1 to 2 years with nurse or primary care physician. Other than high/low risk ▪ Initial follow-up at cancer center for 5 to 10 years, followed by transition to primary care provider, who carries out ongoing monitoring according to follow-up plan established by cancer center. High ▪ Ongoing annual follow-up in specialized long-term follow-up program at cancer center. Hematopoietic cell transplant; high-dose anthracyclines or alkylating agents; radiation ≥24 Gy Adapted from references 27–31.
-
↵aLong-term follow-up begins 2 years following completion of therapy.
-