treatment called chemo-embolization is used to treat childhood liver cancer. This involves injecting chemotherapy drugs into the main artery of the liver with substances that slow or stop tumor growth.


The trajectory of care for children with cancer spans diagnosis and treatment to later stages, including surveillance, rehabilitation, palliation, and end-of-life care. This report focuses on what happens after treatment, and in particular on the care related to late effects of cancer and its treatment. Childhood cancers are a diverse set of diseases and the treatment of each type of cancer varies considerably; and within each type of cancer, the intensity and approach used may vary depending on the child’s age, general health, and characteristics of the cancer. Because late effects arise following an interaction between the individual with cancer, the cancer, and the specifics of treatment, there is no clear map between a particular type of cancer or a specific treatment and an expected spectrum of late effects. Each factor must be considered in anticipating outcomes. Understanding late effects is further complicated by the constant evolution of treatments; they are, in effect, a moving target. While these aspects pose challenges to researchers and clinicians, patterns of late effects have emerged and their recognition has contributed to an appreciation of cancer as a chronic disease.


Cella DF, Tross S. 1986. Psychological adjustment to survival from Hodgkin’s disease. J Consult Clin Psychol 54(5):616-22.

Friedman DL, Himelstein B, Shields CL, Shields JA, Needle M, Miller D, Bunin GR, Meadows AT. 2000. Chemoreduction and local ophthalmic therapy for intraocular retinoblastoma. J Clin Oncol 18(1):12-7.

Institute of Medicine. 2001. Improving Palliative Care for Cancer. Washington, DC: National Academy Press.

Kemper KJ, Wornham WL. 2002. Complementary and Alternative Therapies in Pediatric Oncology. Pizzo PA, Poplack DG (eds). Principles and Practice of Pediatric Oncology. 4th ed. Philadelphia: Lippincott Williams and Wilkins. Pp. 1529-1540.

Neuhouser ML, Patterson RE, Schwartz SM, Hedderson MM, Bowen DJ, Standish LJ. 2001. Use of alternative medicine by children with cancer in Washington State. Prev Med 33(5):347-54.

Roberts CS, Severinsen C, Carraway C, Clark D, Freeman M, Daniel P. 1997. Life changes and problems experienced by young adults with cancer. Journal of Psychosocial Oncology 15(1):15-25.

Robison LL, Mertens AC, Boice JD, Breslow NE, Donaldson SS, Green DM, Li FP, Meadows AT, Mulvihill JJ, Neglia JP, Nesbit ME, Packer RJ, Potter JD, Sklar CA, Smith MA, Stovall M, Strong LC, Yasui Y, Zeltzer LK. 2002. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol 38(4):229-39.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement