Guidelines for Complications of Cancer Treatment Vol VIII Part B

Our ACT model has 3 basic facets; providing longitudinal careat a tertiary care centre. Second, ongoing communication withprimary care provider ensures continuity of follow up andfinally education and empowerment of survivors sensitizesthem towards need for continued surveillance and healthy lifestyle. From Feb 1991 to Feb. 2007, 978 survivors (off therapyand disease free for >2 years) have been enrolled in ACT clinic.Clinical characteristics of survivors are shown in Table I.Highlights of observations are 1) striking male preponderance(3:1) among survivors suggestive of preferential treatment tomale child in our society. 2) Less frequent (8%) grade IIIsequel in survivors of hematolymphoid malignancies vis-àvis.Solid tumors( 26%) highlighting need for fine tuning ofprotocols.3) 212/978 (22%) survivors received cranialirradiation (CI) 142(15%) of these failed to attain normalgrowth potential and half had learning disabilities. CI shouldpreferably be avoided. 4) Increased risk of death attributed tolate recurrence and SMN. Long term follow up strategy shouldbe effective as well as cost-effective and should includesurvivors’ perspective. A special bond established betweenthe survivors and the ACT team consolidates these efforts.The parents use the ACT platform to vocalize their fears, hopes,aspiration and look forward to continue the interaction whichis risk/need based. Risk based follow up care may be the mostappropriate method in our country with diverse socio–demographic, religious and cultural milieu. Creation ofnationwide ACT clinics with tight linkage to primary careproviders would be the right beginning. It would be importantto sensitize primary care practitioners regularly regardingproblems of survivors. Indian National Training Program inPractical Pediatric Oncology (INTPP) could play an importantrole in this direction.419