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Risk-based screening
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 14, 2025 · Captured 2026-09-09.
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The need for long-term follow-up of childhood cancer survivors is supported by the American Society of Pediatric Hematology/Oncology, the International Society of Pediatric Oncology, the American Academy of Pediatrics, the Children’s Oncology Group (COG), and the Institute of Medicine. A risk-based medical follow-up is recommended, which includes a systematic plan for lifelong screening, surveillance, and prevention that incorporates risk estimates based on the following:[49]
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Previous cancer.
Cancer therapy.
Genetic predisposition.
Lifestyle behaviors.
Comorbid conditions.
Sex.
Part of long-term follow-up also focuses on appropriate screening of educational and vocational progress. Specific treatments for childhood cancer, especially those that directly impact nervous system structures, may result in sensory, motor, and neurocognitive deficits that may have adverse effects on functional status, educational attainment, and future vocational opportunities. In support of this, a CCSS investigation observed the following:[50]
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Treatment with cranial radiation doses of 25 Gy or higher was associated with higher odds of unemployment (health related: OR, 3.47; 95% CI, 2.54–4.74; seeking work: OR, 1.77; 95% CI, 1.15–2.71).
Unemployed survivors reported higher levels of poor physical functioning than employed survivors, had lower education and income, and were more likely to be publicly insured than unemployed siblings.
These data emphasize the importance of facilitating survivor access to individualized education services, which has been demonstrated to have a positive impact on education achievement.[51] These services may in turn enhance vocational opportunities.
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In addition to risk-based screening for medical late effects, the impact of health behaviors on cancer-related health risks is also emphasized. Health-promoting behaviors are stressed for survivors of childhood cancer. Educational efforts focused on healthy lifestyle behaviors include the following:
Abstinence from smoking, excess alcohol use, and illicit drug use to reduce the risk of organ toxicity and, potentially, subsequent neoplasms.
Healthy dietary practices (e.g., a diet rich in plant foods and moderate in animal foods) [52] and active lifestyle to reduce treatment-related metabolic and cardiovascular complications.
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Regular physical activity to reduce neurocognitive problems and enhance psychological outcomes.[53,54]
Regular physical activity to reduce neurocognitive problems and enhance psychological outcomes.[53,54]
Survivors who engaged in consistent physical activity over time had fewer neurocognitive problems, including difficulties with task efficiency, emotional regulation, organization, and memory. They also experienced larger neurocognitive improvements, compared with those who had inconsistent activity levels.[53]
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Regular physical activity to reduce neurocognitive problems and enhance psychological outcomes.[53,54]
Vigorous exercise in survivors has been associated with a lower prevalence of depression and somatization, as well as less impairment in physical functioning, general health and vitality, emotional role limitations, and mental health quality-of-life domains.[54]
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Proactively addressing unhealthy and risky behaviors is pertinent because several research investigations confirm that long-term survivors use tobacco and alcohol and have inactive lifestyles despite their increased risk of cardiac, pulmonary, and metabolic late effects.[55-57]
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Preserved source evidence · Not medical advice