Surviving childhood cancer; Now what? Controversies regarding long-term follow-up

Participants generally came away from the SIOP symposium with a consensus that to learn how to care for the growing number of survivors, it is essential that we optimize opportunities for research while maximizing the quality of their clinical care. The final guidelines for clinical care and data collection for this varied group must be targeted, pragmatic and lead to effective interventions. Yet to be decided is the best system for providing clinical care as well as obtaining comprehensive data for research. This is a heterogeneous group of patients with varied needs and differing accessibility to medical care. Four models of care were discussed (Table II): (1) Where the survivor is given the responsibility to seek their own follow-up care, (2) With the local physician in the community directs follow-up care, (3) In a specialty long-term follow-up clinic located at research institutions supervised either by pediatric oncologists, or (4) a new genre of family physicians/internists with knowledge of pediatric cancer late effects and local physicians working in close cooperation with the specialty follow-up clinic. Each model has advantages and disadvantages. Hopefully as our therapies and long-term follow-up care improve, we will observe a corresponding life-long benefit.