Endocrine Abstracts

Overall survival following childhood cancer is 70% and for some conditions in excess of 90%. This success has come at a cost; 60–70% of patients have one or more on-going medical problem. The most frequent conditions encountered are endocrine in nature, ranging from hypothyroidism to panhypopituitarism. In addition, the prevalence of other medical problems is also increased including heart failure and second malignancy. Consequently this cohort of patients require life-long follow-up in a service that provides appropriate management of active medical problems and surveillance for those that may develop in the future.

The ideal service should facilitate seamless care of patients from their initial treatment during childhood to independent young adults with appropriate knowledge of their illness and its consequences. Transition between paediatric and adult services is important. Many patients are lost to follow up during this period so a robust process needs to be in place to ensure the necessary information accompanies the patient during the move between the two services. Each part of the service must provide education, psychological support and access to specialist facilities appropriate to the patient’s age. Clinical Nurse Specialists play an increasing role in Long-Term Follow-Up Services providing necessary education, counselling and nurse lead follow-up clinics.

As the patients grow older they require increasing input from physicians trained in adult medicine. Experience in the management of chronic conditions, general medicine, the transition of patients between childhood and adult services and endocrinology provide endocrinologists with the necessary skills to care for this patient cohort.

The success of paediatric oncologists is being mirrored by their adult colleagues. Increasing numbers of adults are surviving cancer. The lessons learned from services for survivors of childhood cancer can form the basis of care for the increasing number of adult cancer survivors.