Guidelines for Complications of Cancer Treatment Vol VIII Part B

guidelines for screening & management of late effects resultingfrom therapeutic exposures used during treatment for pediatricmalignancies. There are no randomized control trials basedon which level 1 evidence can be generated for formulation ofguidelines. Hence these guidelines represent a statement ofconsensus from a panel of experts .The guidelines are bothevidence based (utilizing established association betweentherapeutic exposures & late effects to identify high riskcategories) & grounded in the collective clinical experienceof experts (matching the magnitude of risk with the intensityof screening recommendations) 12 . To make evidence basedrecommendations for the long term follow up of survivors, ascoring system is used in COG Guidelines. Each score relatesto the strength of association of the identified late effect withthe specific therapeutic exposure based on current literature,and is coupled with a recommendation for periodic healthscreening based on collective clinical experience of panel ofexperts.Explanation of Scoring Used in COG-LTFUGuidelines 13 :Score Statement of consensus1 There is uniform consensus of the panel that (1)There is high-level evidence linking the late effectwith therapeutic exposure and(2) the screeningrecommendation is appropriate based on collectiveclinical experience of panel members.2A There is uniform consensus of the panel that (1)There is lower-level evidence linking the late effectwith therapeutic exposure and(2) the screeningrecommendation is appropriate based on collectiveclinical experience of panel members.Contd...410