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).