Eiser Christine, Absolom Kate, Greenfield Diana, Snowden John, Coleman Robert, Hancock Barry, Davies Helena
Department of Psychology, Western Bank, University of Sheffield, Sheffield, S10 2TP, UK.
J Cancer Surviv. 2007 Mar;1(1):75-86. doi: 10.1007/s11764-007-0006-1.
Recent advances in treatment of childhood cancer have resulted in overall survival rates approaching 75%, but approximately two-thirds experience late-effects related to the disease or treatment. Consequently, recommendations for comprehensive follow-up have been made. As the number of survivors of adult cancers increase, similar concerns about how to provide follow-up and achieve optimal quality of life are being raised. In this paper we propose that management of cancer survivors diagnosed in young adulthood (18-45 years) could benefit from experience gained treating survivors of childhood cancer.
We reviewed research relating to differences in survival rates and late-effects; current arrangements for follow-up; effectiveness; and problems in organization of follow-up separately for survivors of child and adult cancers.
A number of models of follow-up were identified. Rationale for follow-up included early identification and treatment of second cancer and late-effects, health promotion and screening. Increasing numbers of survivors and range of late-effects were identified as problems in organizing services. A possible solution is risk-stratified follow-up, currently being developed in pediatrics.
New models of follow-up are needed that take account of financial costs for health services and survivors' concerns about their current and future health. Implications for continuing refinement of treatment protocols must be an integral part of the service.
International standards are needed to ensure all survivors have access to expert follow-up care and can benefit from new information that might lead to earlier treatment of late-effects.
儿童癌症治疗的最新进展使总体生存率接近75%，但约三分之二的患者会出现与疾病或治疗相关的晚期效应。因此，已提出进行全面随访的建议。随着成年癌症幸存者数量的增加，人们也开始关注如何提供随访以及如何实现最佳生活质量等类似问题。在本文中，我们提出，对青年期（18 - 45岁）确诊的癌症幸存者的管理可以借鉴儿童癌症幸存者的治疗经验。
我们分别回顾了有关儿童和成人癌症幸存者的生存率和晚期效应差异、当前的随访安排、有效性以及随访组织方面的问题的研究。
确定了多种随访模式。随访的理由包括早期发现和治疗二次癌症及晚期效应、健康促进和筛查。幸存者数量的增加以及晚期效应的范围被确定为组织服务方面的问题。一种可能的解决方案是风险分层随访，目前正在儿科领域开展。
需要新的随访模式，要考虑到卫生服务的财务成本以及幸存者对其当前和未来健康的担忧。对治疗方案持续优化的影响必须成为服务的一个组成部分。
需要国际标准来确保所有幸存者都能获得专家随访护理，并能从可能导致晚期效应早期治疗的新信息中受益。
