Survival rates in childhood cancer now approach approximately 65%,
depending on the
specific cancer. Success has been achieved through the use of increasingly
aggressive
treatments (chemotherapy, radiotherapy, bone-marrow transplantation). These
are now
recognised to be associated with a range of physical late effects, including
problems
associated with growth and endocrine function, sensory function, fertility,
liver, cardiac, and
kidney damage. Recognition of these physical late effects raises the issue
of related problems
in psychological, educational, and behavioural functioning. There is considerable
evidence
to suggest that children who are younger on diagnosis are more at risk
in terms of cognitive
and behavioural late effects compared with those who are diagnosed later.
Cancer remains
a rare disease in children and consequently only those professionals attached
to centres
specialising in the care of children with cancer are likely to receive
a significant number of
referrals. It is important to establish a psychological support service
as an integral part of
long-term care in order to (a) establish more accurately the incidence
of social and
psychological late effects and (b) offer advice to the individual about
the possible long-term
effects of cancer treatment on future health, social, and employment prospects.