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Follow-up

Issue

Importance of continued medical follow-up: for future developments In medicine and for your own health.

Background

Survivors of childhood cancer are now growing into adulthood. It is important to continue to have close medical follow-up to detect early any problems that may be a consequence of having had cancer or the cancer treatment. This will not only benefit your health, but also provide information to medical science on potential unknown long-term effects.

Information

It is forecasted that one in every one-thousand adults, by the year 2000, will have been a survivor of childhood cancer. Although the treatment of cancer is what saved their lives, it is unknown what long term complications will result from the treatment as the survivors grow older. Therefore, it is important to continue to have an annual medical examination to detect any problems early. In addition, if medical problems do occur as a result of the prior cancer or treatment, this should be reported by the health care provider to the original treatment medical center. It will be important to collect comprehensive information concerning the long-term medical risks of cancer and of specific treatment regimens in order to better monitor the health status of survivors. This information could potentially prevent these future complications in children presently receiving therapy.

There are other simple follow-up tests which may be needed depending on the type of cancer and treatment you received. The following tables outline the recommended medical follow-up specific to each treatment. Ask your doctor or nurse to point out the treatment you received and review the recommendations with them.

Treatment	Organ Affected	Screening Tests	Suggestions
Surgery
Nephrectomy	kidney	Chemistry profile, urinalysis, and blood pressure checks	Exercise moderately but avoid contact sports
Splenectomy	spleen	complete blood count	See your doctor promptly for fever >101.0F, some doctors may recommend prophylactic antibiotic
Radiation
Abdomen	kidney, liver, bladder	chemistry profile, urinalysis every 3-5 years and blood pressure checks annually	Report any change in stool or blood in stool
Chest	lungs, breast	Pulmonary function tests if short of breath, monthly self breat exam, exam yearly by a doctor, mammogram periodically after age 25	Do not smoke, avoid exposure to passive smoke, breast self exam monthly
Cranial	delay in growth, secondary sex characteristics, possible learning defects	Endocrine evaluation, neuro-psychological testing available upon request, monitor sexual maturation annually	Growth hormone may be considered for growth failure
Head/neck	eyes, teeth, thyroid gland, pituitary gland	Annual eye exam, dental exam every six months, thyroid function tests, monitor sexual maturation yearly	Maintain good oral/dental hygiene, report difficulty swallowing
Groin	ovaries	Pelvic exam annually by a doctor	Consider not delaying childbearing if having regular periods, hormone replacement may be necessary if there is ovarian damage
Lower abdomen	testes	Testicular self exam every month, testicular exam annually by a doctor, sperm count if fertility is in doubt	Testosterone hormone replacement may be indicated
Extremities	arms, legs	Annual exam of extremities	May require modified sports and exercise program- Ask your doctor
Spine/Back	spine	Check for scoliosis yearly
Chemotherapy
Actinomycin D/ ARA-C	liver	Chemistry profile
Adriamycin/ Daunomycin/ Idarubicin	heart	Echocardiogram, cardiac evaluation every five years if normal, cardiology consult if abnormal	Consult doctor before starting a strenuous exercise or weight lifting program, Provide cumulative anthracyline dose information prior to any surgery or during pregnancy
BCNU/ CCNU/ Bleomycin/ Busulfan	sex organs, lungs	Pelvic exam, sperm count if fertility in doubt, pulmonary function test every 3-5 yrs, CXR every 3-5 yrs	Consider not delaying childbearing if having regular periods, Provide dose information prior to any surgery, consult a doctor before starting a strenuous exercise program
Cisplatin/ Carboplatin	kidneys, bladder, sex organs, hearing	Chemistry profile with electrolytes, urinalysis every 3-5 years, regular blood pressure checks, pelvic exam yearly, sperm count if fertility is in doubt, audiogram if having hearing difficulties	Consider not delay childbearing if having regular periods
Cytoxan/ Ifosfamide	kidneys, bladder, sex organs	Same as above except audiogram	Same as above
DTIC	liver	Chemistry profile
L-asparaginase, Peg-asparaginase	liver (rare) pancreas (rare)	Chemistry profile
Methotrexate	liver	Chemistry profile
Nitrogen Mustard	sex organs	Pelvic exam yearly, sperm count if fertility is in doubt	Consider not delaying childbearing if having regular periods
Procarbazine	sex organs, liver, kidney	Pelvic exam yearly, sperm count if fertility is in doubt, urinalysis, chemistry profile	Avoid drinking alcohol, consider not delaying childbearing if having regular periods
6-Mecaptopurine 6-Thioguanine	liver	Chemistry profile
Vincristine, Velban/VP-16	liver	Chemistry profile
Intrathecal chemotherapy	possible learning deficits	Neuro-psychological testing available
Blood Transfusions	liver, immune system	Chemistry profile, hepatitis C test, complete blood count, AIDs virus test if there is a concern	Practice safe sex

Note

At present there is no one clearinghouse to collect information on long-term complications of childhood cancer. Until such time, all concerns should best be directed to the institution that originally treated the cancer.

Resources

"Caring for Life" booklet
Prepared by: Jerelyn Moffet, RN, MS,CSNP; Peggy Possin, RN, BSN; Sharon Frierdich, RN, MS, CPNP; Paul Gaynon, MD

Schwartz CL. Complications of treatment: Late effects of treatment in long-term survivors of cancer. Cancer Treatment Review l995, 21:355-366.

Nessim, S and Ellis, J. Cancervive: The challenge of life after cancer. Houghton Mifflin Co., Boston, 1991.