During the past decades, significant advances have been made in the treatment of pediatric malignancies, with more than 80% of children being cured in developed countries. Therapy responsible for this survival rate can also produce adverse long-term health-related outcomes, referred to as late effects. Late effects manifest months to decades after the completion of cancer treatment. It is estimated that more than 60% of pediatric cancer survivors develop at least one chronic condition and almost 30% experience serious or life-threatening complications during adulthood. The common late effects of childhood cancer encompass several broad domains including growth and development, organ function, reproductive capacity, secondary malignancies, and psychosocial sequelae. Late effects can be anticipated based on therapeutic interventions, but the magnitude of risk and the manifestations in an individual survivor are influenced by numerous factors which are tumor-related, treatment-related, and host-related. Any organ system can be affected. Late effects also contribute to an excess risk of premature death among long-term survivors. Relapsed primary cancer remains the most frequent cause of death, followed by cause-specific mortality from subsequent primary neoplasms, and cardiac and pulmonary toxicity.
Childhood cancer survivorship is a national public health priority. Long-term follow-up care has taken place in a variety of settings: primary care clinics (pediatrics, internal medicine, family practice), oncology clinics (pediatric and adult), and specialized long-term follow-up clinics. To facilitate survivor and provider access to appropriate follow-up care, compendium of exposure- and risk-based health surveillance recommendations has been developed, including guidelines, health links and comprehensive reviews.