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The community health care provider will at some point be faced with caring for a survivor of childhood cancer. This may be episodic care or follow-up care for the cancer and treatment. Approximately 1 of every 250 persons living in the United States today has been diagnosed or will be diagnosed with cancer before the age of 20. Prior to 1960, nearly all children diagnosed with cancer died of their disease. Since 1960, however, due to innovative and combined treatment modalities, the rate of survival for childhood cancers has been climbing rapidly. Current estimates are that 80% of all patients diagnosed with cancer who are less than 20 years of age will now be cured. However, many will suffer long-term health sequelae of their cancer and treatment (1-4). This represents a rapidly growing group of individuals who have survived both their cancer and their cancer treatment; currently it is estimated to comprise about 328,600 individuals in the United States (1-4). Many of these patients are followed in one of the 145 clinics, located in the United States and Canada, identified by the Children's Oncology Group (COG) Late-Effects Directory of Services (www.childrensoncologygroup.org). However, many of the 328,600 living survivors of childhood cancer are followed by pediatric practitioners, family practice practitioners, general practitioners, internists, or health clinics at colleges or universities. These practitioners may have little or no experience in managing late effects of childhood cancer and cancer treatment or in addressing cancer survivorship issues.

Over the last 30 years, researchers have identified many potential late effects of childhood cancer and the treatments. Based on this research, the Long-Term Follow-Up Guidelines were developed by committees of experts in the COG. These guidelines were developed as a resource of clinicians who provide ongoing health care to survivors of pediatric malignancies. While these guidelines are written primarily for pediatric oncologists who are familiar with the long-term follow-up needs of this population, they can also assist the community physician. The ideal care is a partnership between the original treating center and the community physicians. Most Long-Term Follow-Up Clinics now try to provide a "Passport for Care" that summarizes the patient's treatment and recommendations for follow-up care (5).

The first intervention for the community physician when managing the long-term survivor of childhood cancer is to obtain an accurate cancer diagnosis, a complete treatment history, a family history of cancer, and information on any known existing late effects. It is often necessary to contact the physician or institution where the child received either treatment or previous late-effect surveillance. The patient and his or her family may or may not be accurate historians; therefore, it is extremely important to obtain copies of the pathology report and treatment record. Communication with the attending oncologist or a copy of the Passport for Care may be invaluable. Only by being aware of the diagnosis, treatments, and family history can proper surveillance be performed (...

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