Guidelines for Complications of Cancer Treatment Vol VIII Part B

Contd...Score2BStatement of consensusThere is non-uniform consensus of the panel that(1) There is lower-level evidence linking the lateeffect with therapeutic exposure and (2) thescreening recommendation is appropriate based oncollective clinical experience of panel members.3 There is major disagreement that therecommendation is appropriate.The COG Guidelines emphasize the need for a thorough history& physical examination as the primary assessment for cancerrelated late effects during periodic screening. Recommendation& frequency of investigations are based on the score; thusreducing the burden of unnecessary investigations. Details onsystem wise late effects, possible causative agents,recommended evaluation & frequency of monitoring for lateeffects can be accessed on the COG website(www.survivorshipguidelines.org).However, stringent COG guidelines are difficult to adopt indeveloping countries like India due to logistic and financialconstraints. To ensure compliance on ongoing basis, a morepractical follow up strategy is suggested by the Scottishguidelines 14 for long-term follow-up of childhood cancersurvivors based on the intensity of therapy received. 15 Thethree levels of follow up recommended are summarized intable below. To optimize the follow-up of long-term survivorseach centre should adopt its own policy keeping in mind thebasic guiding principles of existing international standards andstrategies.411