title: Survivor care for pediatric cancer survivors: a continuously evolving discipline.
abstract: OBJECTIVE
  This article summarizes recent findings regarding the prevalence of chronic health conditions, cardiovascular and pulmonary late effects, and second malignancies in childhood cancer survivors (CCSs), and examines facilitators and barriers to survivor care.
  
  
  RESULTS
  The estimated cumulative prevalence for a serious chronic disease in CCSs is 80% by age 45. The crude prevalence for cardiac conditions is 56.4% and for pulmonary dysfunction is 65.2%. Research in cardio-oncology is focused on better methods of predicting risk for cardiac dysfunction, and better methods of detection and interventions to prevent cardiac late effects. Pulmonary late effects, recognized to be a significant cause of late mortality, were detected by surveillance tests in more than 50% of CCSs but are often subclinical. Rates of subsequent malignant neoplasm continue to increase as the population ages. All of these factors make it clear that life-long surveillance is required and models of care should consider risk for late effects and socioeconomic and patient-specific factors.
  
  
  CONCLUSIONS
  It is becoming clear that there is no age after which the occurrence of late effects plateaus and surveillance can be reduced. Survivors should be empowered to advocate for their survivor care and options for follow-up should be tailored to their needs.
authors.affiliation: aAflac Cancer and Blood Disorders Center/Children's Healthcare of Atlanta bDepartment of Pediatric Hematology/Oncology and Endocrinology, Emory University, Atlanta, Georgia, USA.
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Record
authors.forename: Lillian R
authors.initials: LR
authors.lastname: Meacham
mesh_terms: D000328:Adult; D000367:Age Factors; D018943:Anthracyclines / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D002648:Child; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D017741:Survivors; D055815:Young Adult
chemical_list: D018943:Anthracyclines