Introduction:
The advances and successes in treating cancer patients in childhood have increased the survivorship of the patients into adulthood. There are many sequeles of the long-term therapies needed for the treatment in this growing population, and more people are affected. After being treated, the child will likely have a regular follow-up to monitor the results, intervene, and detect any new abnormality if it arises. Educating the family well and raising their awareness about healthcare is to be focussed on to reduce the risk of developing health problems. All healthcare professionals, including pediatricians and oncologists, play a very important role in helping cancer survivors by taking preventive measures and supervising and providing health education.
What Is the History of Cancers in Children?
Almost 12,500 children below the age of 20 years are being diagnosed with different cancers in the United States. The children who had cancer before the 1970s did not survive this disease. The rapid advancements in technology and increasing treatment options have allowed cancer survivors to reach adulthood with the help of increased knowledge, research, and intensive care support. The survival rate of cancer survivor children has increased up to 80 percent. Approximately 3 lack cancer survivors are being treated in the United States currently. 10 percent of cancer-affected children are still not getting treatment because of in-home stay. This makes childhood cancer misdiagnosed, and not proper care is delivered to the affected child. Usually, the age group affected is 0-14 years of age. There are chances of children from 15-19 years of adolescence to get affected by cancers. Treatment has a multidisciplinary approach; the most involved specialists include pediatric oncologists. Parents and caregivers play a vital role in the efficacy of treatment outcomes in pediatric cancer survivors.
How Do Cancer Survivors Adjust Psychosocially?
Childhood cancer survivors face both physical and mental problems. The parents of such children complain that their children are usually in a bad mood compared to their friends. In most cases, the parents and children are motivated and show a positive attitude. The Children's Depression Inventory (CDI) was conducted on children, and there was not much significant difference in the CDI scores of cancer survivor children and the normal group. The CDI score of each child is highly impacted by the attitude of the patient and the parents and the comorbidities associated with the disease. Many other factors affect the psychology of the child after fighting cancer. These include the health after diagnosis, the age of the child, and family support. Some parents suffer from guilt for not taking proper care of their children. As the treatment of children suffering from cancer goes on for a long, it is important to be aware of any parental guilt. The cancer diagnosis has a long-lasting impact on the child as well as the parents. There, in turn, is a long-term impact on many aspects of patients' mental and psychological development. The therapy includes counseling with a pediatric psychologist and social workers and also educating the families.`
What Are the Long-Term Follow-up Guidelines for Pediatric Cancer Survivors?
In January 2002, at the request of the Institute of Medicine, a panel with multidisciplinary departments within the COG (Children oncology group) started to develop a screening and overall management of the complications associated with late treatment therapies of childhood cancer survivors. This resulted in the development of Long-term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers to raise awareness and education related to late treatment sequelae for early diagnosis and intervention of the complications associated with cancer.
Malignancies of childhood show different histological presentations and are heterogeneous. Over 20 years, the protocol for treating biologically favorable cancers in patients has changed to modified treatments and focuses on reducing therapy-related complications. For severe cancers, the treatments have also been modified to control the disease and ensure long-term survival. All children who survive cancer are at different risks of getting late cancer therapy complications. Longer duration chemotherapy may increase the risk of post-therapy complications. The type and intensity of the chemotherapy and radiotherapy are related to the risk of development of late complications.
Care and plan for lifelong prevention and screening incorporate risk depending on previous cancers, lifestyle, and health conditions of the survivors. The care related to risks includes the detailed history of previous cancer, such as the date of diagnosis, histology, organs or tissue affected, and the specific treatment, such as surgery or therapy.
Care management for cancer survivors includes creating awareness and screening. Long-term care of children can be adapted from COG LTFU (Children oncology group long-term follow-up). A proper survival care plan by a specialist or with other experts is created. The guidelines provide information allowing physicians to pepper treatment related to health risks, and awareness may extend to families.
The specialists involved in cancer treatment in a pediatric patient include a pediatric oncologist, pediatric surgeon, adolescent oncologist, and pediatric hematologist-oncologist.
What Is the Future of Treatment for Pediatric Cancer Survivors?
Increasing cohort studies on pediatric cancer survivors and expanding research as there is limited capacity. Attempts should be made to decentralize care by developing multicentric networks for the long-term effects and providing standard care. Advanced technologies can facilitate care for survivors, primarily adolescents and young adults. The focus should be on improving communication and educating the parent and the survivor. Research should be carried out to minimize late toxicities associated with cancer survivors, such as brain tumors, neurocognitive issues, and azoospermia.
Conclusion:
It is essential for children who have survived cancer to receive a long-term follow-up from the specialist. It should include a multidisciplinary approach, including all the experts. Awareness and education of the patient and the family should be of primary focus. Pediatricians should be educated about the COG LTFU guidelines. The ultimate aim should be to provide high-quality care by the pediatric center and the associated pediatrician. Different foundation funds support the patients and families at hospitals. The emotional challenges faced by the parents can affect the treatment of the child, parenting, and the support that is desired for the efficient outcome of the treatment of children.
