Pediatric Oncology
Education Materials

General:

• Level of energy, general health
• Depression
• Social/employment situation
• Exercise
• Smoking, recreational drugs and alcohol ingestion

Chemotherapy related:

• Symptoms of cardiac dysfunction related to Adriamycin induced cardiomyopathy (e.g. shortness of breath on exertion, palpitations and orthopnoea)
• Hearing problems related to Cisplatin
• Problems with fertility related to alkylating agent exposure
• Back pain, history of fractures - after intensive chemotherapy patients are more at risk for osteoporosis

Pelvic OS:

• Pelvic and joint pain

Limb OS:

• Limb pain, swelling, joint pain and dysfunction
• Prosthesis function

General:

• Blood pressure
• Weight and height (BMI)
• General examination

Pelvic OS:

• Check for limb swelling (lymphedema)

Limb OS:

• Check limb length, joint function and for swelling
• After amputation, health of stump (?pressure sore/swelling)

General:

• Routine blood work including blood count (risk of secondary AML after alkylating agents), serum LDH. electrolytes, BUN and creatinine (risk of renal dysfuntion), serum magnesium and liver function tests
• Hepatitis C testing if blood product transfusion prior to 1994

General OS: These investigations are done more frequently immediately after the end of therapy and then subsequently the timing is controversial:

• CT of chest to exclude pulmonary relapse
• Bone scan

Thoracic OS:

• CT of chest
• Pulmonary function tests if indicated

Pelvic OS:

• MR of pelvis (frequency every year or so after end of therapy - then subsequent follow up controversial)

Extremity OS:

• Intermittent MR scan of previous disease site (frequency every year or so after end of therapy - then subsequent follow up controversial)

General:

• Any adriamycin exposure - echocardiogram every 2-3 years or so

Hearing:

• Audiology testing every one to two years to assess for hearing loss

Specialist

follow-up

General:

• Anyone who has had intensive chemotherapy is at risk for early onset osteoporosis and should be seen in consultation by a specialist with expertise in this area.
• Fertility specialist (alkylating chemotherapy)
• May need to see a respirologist (pulmonary damage related to Bleomycin)

• Family counselling
• Psychology
• Psychiatry

General: The patient should seek immediate medical help if a new swelling (painless or painful) appears as this may be due to a second malignant neoplasm.

Lifestyle:

• Advise about diet, exercise and lifestyle choices (such as smoking) which increase the risk of long term health problems.
• Diet rich in Vitamin D, calcium and dairy servings to reduce risk of osteoporosis. 
• Regular exercise is very important. Almost all OS patients will have been exposed to adriamycin and to be at risk for cardiomyopathy. Cardiac fitness is very important.         

Patient information

(COG) Survivorship Guidelines

General:

• Reducing the risk of second cancers
• Heart health
• Bone health
• Pulmonary health
• Kidney health
• Female health
• Male health

Limb OS:

• Limb sparing procedures
• Amputation