Hospital follow-up services not necessary for all child cancer survivors

Many child cancer patients will benefit from ongoing follow-up, but others should be allowed to move on and put the experience of cancer behind them, say experts in this week's issue of the BMJ.

Most adults who survive cancer are discharged from active follow-up after five years, but historically children have been followed up for life, however this is becoming unsustainable, write Meriel Jenney from the Children's Hospital for Wales and Gill Levitt from Great Ormond Street Hospital.

Follow-up of children who survive cancer should be individually tailored and may not be necessary for all, they argue.

Previous studies have shown that at least 62% of child survivors have some late side effects as a result of their curative treatment. But this data is based on different treatments than those used today. For example, many of the late side effects seen in older studies were caused by radiotherapy, a treatment that is now used less frequently.

More than three quarters of children with cancer now survive into adulthood, but how can a follow-up service be developed for this growing and diverse group of patients, ask the authors.

Patients who are at high risk of late side effects—such as those who have received a bone marrow transplant—will require ongoing observation by skilled clinicians in a hospital setting.

But for an increasing number of patients who are at low risk of late side effects, an accessible summary of the patient's previous treatment with a plan for any necessary investigations and likely late side effects, managed by primary care doctors, could be the solution, suggest the authors.

As long as there is a mechanism in place to recall any patient for a more detailed follow up if new late side effects are identified, only those with the highest risk of late effects should be brought back regularly to the clinic, say the authors.

The other patients must be allowed to move on, to leave the clinical setting and put the experience of cancer behind them, or they may never believe they have been cured, they conclude.