The use of aggressive multimodal therapy has helped improve the odds of survival for childhood cancer victims. It is estimated that by the year 2000, one in every 900 people between the ages of 15 and 45 years will have survived childhood cancer. However, these cancer survivors remain at risk for a number of disorders related to the disease and its treatment. The FACT program at MUSC's Hollings Cancer Center provides comprehensive assessment and treatment for these children's and young adult's special needs.

Special Needs of Survivors

While multimodal therapy may save lives, treatment is not perfect. Because of genetic susceptibility and therapy received to treat the primary cancer, child cancer survivors have a greater risk of a secondary malignancy. In addition, radiation therapy can cause growth retardation, scoliosis, hypothyroidism, reduced fertility, cardiac toxicities, pulmonary damage, cognitive deficits and problems of the central nervous system. Medicines such as anthracyclines bleomysin can cause heart and lung problems many years after therapy. These risks make it necessary for childhood cancer survivors to receive annual specialized checkups and education on the best ways to ward off future illness. Follow-up After Cancer Treatment, or FACT, meets these children's needs.

FACT

Patients involved in FACT receive a yearly checkup from a team of pediatric specialists who thoroughly assess them for the potential problems cancer survivors face. This team includes a pediatric oncologist, pediatric nurse practitioner, radiation oncologist, endocrinologist and cardiologist. Patients will see the appropriate specialists based on the cancer treatments (radiation, surgery, chemotherapy) they received. Because chemotherapy can cause early tooth loss and dental decay, each patient is also seen by a pediatric dentist for education and prevention.

A child life specialist assesses the patient's feelings about cancer to determine if depression or anxiety about the experience remain. These specialists use play therapy to teach patients about cancer and coping strategies. A social worker is available to help families with the financial issues involved, such as difficulties for families denied insurance following treatment.

Prevention and Education

The nursing staff works with children and their parents to teach them about the illness and ways to prevent recurrence through healthy eating, skin protection and, for older survivors, breast and testicular exams. The FACT program is open to children and young adults who have been off chemotherapy for at least two years and who have been disease-free for five, regardless of where they received treatment. Primary care providers receive a report with notes from each specialist. Staff members are also available to primary care physicians for consultation.

For consultation or referrals, call MUSC Health Connection at 792-1414.

Editor's note: The article is reprinted from MDialogue newsletter, a physician liaison program publication.