Follow-up after treatment for childhood bone cancer
Follow-up after treatment is an important part of cancer care. Follow-up for childhood bone cancer is often shared among doctors and healthcare professionals, including physical therapists, occupational therapists, audiologists, speech-language pathologists, dentists, eye doctors, nurses and psychologists. This healthcare team will work with you to decide on follow-up care to meet your child’s needs.
Some centres have aftercare clinics that specialize in follow-up for survivors of childhood cancer. Long-term follow-up is important for children because there is a chance that cancer can come back, or recur, and late side effects from treatment can develop. People who have a childhood cancer are often followed in aftercare programs for life. The Children’s Oncology Group (COG) provides long-term follow-up guidelines for childhood cancer survivors.
Some centres across Canada have transition clinics set up to follow the survivors of childhood cancer. Transition clinics help prepare survivors who are reaching early adulthood to successfully transition to the world of adult healthcare.
Don’t wait until your child’s next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell the healthcare team if your child has:
- swelling or a lump
The chance of childhood bone cancer recurring is greatest within 5 years, so close follow-up is needed during this time.
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The healthcare team will follow all children treated for bone cancer to make sure they are growing and developing normally.
Children who have limb-sparing surgery need careful orthopedic follow-up. They will also need to see a rehabilitation medicine specialist, physiotherapist and occupational therapist.
Children who have limb-sparing surgery or amputation often need life-long follow-up with an orthopedic surgeon.
Follow-up visits with the healthcare team are usually scheduled:
- every 3 months for the first 2 years after treatment
- every 6 months for the next 3 years
- every year for the next 5 years
- every 2–3 years once 10 years have passed after treatment
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During a follow-up visit, your child’s healthcare team will usually ask questions about the side effects of treatment and how your child is coping. The doctor may do a physical exam, including:
- feeling the lymph nodes
- examining the area where the primary tumour was
- checking that the child is growing normally
- checking that the child’s sexual development is normal
Tests are often part of follow-up care. Your child may have:
- blood tests to check organ function
- bone scan
- CT scan or MRI of the primary tumour site
- x-ray or CT scan of the chest
- echocardiogram to check heart function
Children under the age of 16 who have limb-sparing surgery need to have yearly x-rays to check:
- if limbs are different lengths
- grafts or implants to find out if they are healing properly or not (called non-union)
- grafts for breaks, or fractures
- implants to make sure they are not loose (a loose implant is called stem loosening)
If a recurrence or other problems are found during follow-up visits, the healthcare team will assess your child to determine the best treatment options. Some children may be referred to an endocrinologist if there are any problems with their sexual development.
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American Cancer Society. Ewing Family of Tumors. 2014: http://www.cancer.org/acs/groups/cid/documents/webcontent/003099-pdf.pdf.
American Society of Clinical Oncology. Ewing Sarcoma - Childhood. 2014: http://www.cancer.net/cancer-types/ewing-sarcoma-childhood/view-all.
Hendershot, E . Ewing's Sarcoma Family of Tumors. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.3: pp. 37-41.
Hendershot, E . Osteosarcoma. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.4: pp. 41-44.
Macmillan Cancer Support. Ewing's Sarcoma in Children. Macmillan Cancer Support; 2013: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Ewingssarcoma.aspx.
Macmillan Cancer Support. Osteosarcoma in Children. Macmillan Cancer Support; 2013: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Childrenscancers/Typesofchildrenscancers/Osteosarcoma.aspx.
Morgan, H and Conrad, E.U.III . Limb salvage and spinal surgery. Wallace, H. & Green, D. M. Late Effects of Childhood Cancer. London, UK: Arnold; 2004: 9c:pp.293-303.