The follow-up phase of care is the time after completion of the initial course of therapy. Children and young adults may be monitored by their pediatric oncologist following treatment for 3 years or more, depending on the disease, age of the patient, and other factors. Follow-up by pediatric oncologists typically focuses on checking for recurrence. More extensive follow-up might be offered by the treating oncologist or take place through a referral to a comprehensive clinic. Comprehensive follow-up care includes assessment of short- and long-term complications and sequelae of cancer therapies, detection of recurrent and secondary cancers, counseling about behaviors such as smoking to prevent secondary cancers, assessment of psychosocial adjustment and quality of life, and treatment for any identified late effects. Lifelong follow-up is often necessary to identify problems following cancer treatment. Such care may be provided in the context of a special late-effects clinic or become an integral part of primary care; however, evidence suggests that follow-up care is not routinely provided (see Chapter 5).
Cancer may recur in the same part of the body where it was found originally (local recurrence), or it may reappear in a more distant part of the body (metastasis). The type of treatment that is selected for a recurring cancer depends on the specific type of cancer, its size, how it behaves biologically, and what previous therapy was given. Recurrent cancers can be cured, but the likelihood of cure is usually far lower than it is for the initial treatment of cancer. If childhood cancer recurs, it usually does so in the first few years following treatment. Late effects are predictably more frequent and severe in survivors treated for relapse.
The diagnosis of cancer in a child constitutes a family crisis—normal daily life is disrupted, and shock, disbelief, and grief may interfere with parents’ ability to cope with new information and the need to make decisions. Children may be fearful and in pain, and may react with unusual behavior and moods. Families may benefit from the services of psychologists, social workers, and oncology nurses as they attempt to cope with the diagnosis and subsequent treatment. As patients and their families complete primary treatment, sources of continued support may include community-based parent self-help organizations (e.g., Candlelighters Childhood Cancer Foundation), cancer survivor day celebrations, oncology camps,