Guidelines for Complications of Cancer Treatment Vol VIII Part B

with age, often becoming clinically apparent decades aftertherapy. 4The degree of late effects is essentially a function of 3 typesof factors which include a) tumor-related factors such ashistology, site and biology b) treatment-related factors suchas type of radiation therapy(dose/fraction size/volume/machineenergy), chemotherapy (type/ dose/ schedule), and surgery(site/technique), and c) host-related factors such asdevelopmental status, genetic predisposition, organ function,premorbid state, inherent tissue sensitivity and capacity ofnormal tissue repair.Long Term Follow up at Tata MemorialHospitalTo prevent or ameliorate late effects by early diagnosis withtherapeutic intervention, a common approach is to adopt anindividualized life long health care plan for each survivorencompassing screening, surveillance and prevention thatincorporates risks which in turn depends on the site ofunderlying malignancy, the type & intensity of treatment andage at treatment. One such model was established at St. JudeChildren’s Research Hospital, USA. 5 Drawing inspiration fromthe same, the Tata Memorial Hospital After Completion ofTherapy (ACT) Clinic was initiated as a follow up clinic forlong term survivors of childhood cancer in February 1991. 6The aims of the clinic are to monitor growth, development,and sexual maturation, as well as the somatic late effects oftherapy and to apply corrective measures whenever feasible.Our ACT model addresses 3 basic facets of childhood cancersurvivor care by providing 1) longitudinal care at a tertiarycancer centre by a single physician coordinator who integratespatient care, education and research; 2) ongoingcommunication with primary care provider to ensure continuityof follow up; and 3) education and empowerment of survivors408