Answers to Questions

The LTFU Clinic was created to help pediatric cancer survivors answer questions about their past medical condition, their medical histories, and to assist them as they move through life. This is a new and evolving area of medical treatment.

“We are seeing patients who have been treated with chemotherapy in the past, and who are looking now at the impact of the chemotherapy on their physical well-being, growth and development, and fertility,” says Laurence Boxer, M.D., Director of Pediatric Hematology/Oncology.

“We transition our patients to the LTFU five years after their initial cancer diagnosis. In addition to assisting patients with their treatment-related issues, we need to learn what effect time and the aging process will have on cancer survivors. As we learn more about the long-term side effects of therapy, we can begin to modify current cancer therapy in the hope of diminishing the toxic effects,” says Marcia Leonard, nurse practitioner in the Pediatric Hematology/Oncology Clinic.

In some situations, the Clinic may discover that specific treatment might make former patients more susceptible to other cancers. For instance, “We found out that girls who received radiation to their breast when they were young teenagers are at 35 times the risk of developing breast cancer. So we bring them back to inform them about getting mammograms,” says Leonard.

Long-term effects seen in pediatric cancer survivors include problems with growth and development, complications from prior surgery, organ system abnormalities from drugs and radiation therapies, potential problems with fertility, and the small but real risk of developing new cancers.

Care for Now and the Future

All patients in the Clinic receive a personalized summary of their treatment history along with recommendations for their present and future care. “These patients were often just kids when they were here for treatment. Frequently, they do not know exactly why they were here and what treatment they had,” explains Leonard. The summary includes a comprehensive review of what and where their disease is, what treatments they received, and how both may impact their life now and in the future.

According to Boxer, the goals of therapy in the Pediatric Hematology/ Oncology Clinic are to “achieve a 100 percent success cure rate, but also to minimalize the toxic effect of the treatment. In order to lessen the toxic or long-term effect, the Long Term Follow Up Clinic is most important.”

Adds Leonard, “There’s an expression called the ‘truly cured child.’ That’s the vision of our efforts.”