Medical Screening Participation in the Childhood Cancer Survivor Study

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Abstract
Improvement in the rates of childhood cancer survival has prompted greater awareness of late treatment-related morbidity. Among the potential sequelae of therapy are osteoporosis, cardiomyopathy, and secondary neoplasms.1-4 The Children's Oncology Group has compiled risk-based, exposure-related clinical practice guidelines for screening and management of late effects resulting from treatment of pediatric cancers.5 A baseline echocardiographic screening is recommended for survivors at entry to long-term follow-up and then periodically based on age at treatment, radiation dosage, and cumulative anthracycline dosage (Table 1). Survivors who are at highest risk and, therefore, should undergo more frequent screening are those who were younger than 5 years at treatment and who received any anthracycline therapy or who had any radiation exposure. Baseline dual-energy x-ray absorptiometry screening for bone density is recommended at entry to long-term follow-up and is repeated as clinically indicated (Table 1). While exposure-based guidelines for screening for the late effects of pediatric cancer treatment have been established, survivor medical screening practices are suboptimal.6-8