Your child should visit his or her pediatrician or primary care physician at least once a year for a complete physical exam and any additional needed tests. Your child should visit the doctor regularly to:
- enable doctors to assess the full effect of therapy
- detect and treat disease recurrence
- identify and manage long-term and late effects of treatment
Regular examinations include screening for cancer and long-term and late effects of treatment. Survivors don't necessarily need a cancer specialist for routine checkups and screening, but they do need to see doctors who understand their previous treatment and its risks. Coordination between specialists and your child's pediatrician or primary care physician is essential to provide the best care.
Your pediatrician should also recommend a schedule for having your child's learning skills assessed. If your child appears to be experiencing learning disabilities, special education methods can help.
The type and frequency of exams and screenings your child needs depends on the type of cancer treatment or cancer drugs he or she received. Below are general guidelines for several therapies:
- Radiation therapy: Yearly physical exams, including growth, thyroid, bone and hormone monitoring. Girls who had radiation therapy in the chest area (mediastinal) should:
- perform monthly self-breast exams
- get a baseline mammogram at age 25 to 30, or 10 years after radiation therapy
- get an annual clinical breast exam
- have a mammogram every two to three years, depending on breast tissue density
- Cranial radiation therapy: Neurocognitive testing at baseline, then whenever the clinical need arises.
- Anthracycline, high-dose cyclophosphamide or mediastinal or spinal radiation therapy: Baseline testing for heart function, then every three to five years after treatment or as needed if abnormalities are present.
- Chest or mediastinal radiation, bleomycin or carmustine or lomustine therapy: Baseline lung function testing, then every three to five years as needed. Educate your children on the importance of not smoking.
- Cisplatin or carboplatin: Creatinine clearance measurements taken at baseline, then every three to five years as needed.
- Ifosfamide: Yearly monitoring for evidence of Fanconi syndrome, a type of kidney problem.
- 6-mercaptopurine, methotrexate, actinomycin-D or abdominal radiation therapy: Liver function tests every one to three years.
- Etoposide or alkylating agents: Annual complete blood counts (CBCs) for evidence of myelodysplasia or a secondary leukemia.
Some treatment centers offer comprehensive follow-up care clinics for childhood cancer survivors. To find one near you, visit The Pediatric Oncology Resource Center.
When choosing a survivor program or treatment center for your child, you have several options to consider:
- Survivorship programs that focus on life after cancer are at several major hospitals around the country.
- Some treatment centers have follow-up clinics that provide a multidisciplinary approach to monitoring and supporting cancer survivors.
- Some follow-up clinics specialize in pediatric cancer survivors.