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A special niche forMPO

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Medical and Pediatric Oncology 32:403 (1999)
A Special Niche for MPO
Medical and Pediatric Oncology (MPO) offers a particular opportunity to bridge the age gap and provide a
forum for discussion of issues relevant to adult survivors
of cancer in childhood and adolescence, who represent an
expanding population [1]. (See the article on pp 404–410
of this issue for an overview of the special circumstances
surrounding the adolescent with cancer.)
The litany of late effects, to which children and adolescents cured of cancer are prone [2,3], places unusual
and additional demands on health care systems and the
professionals who provide them. In addition to specific
morbidities, these survivors face challenges with respect
to employability and insurability, all of which impact on
quality of life [4]. Recognition of the importance of these
matters, which reflect what Dr. Jan van Eys has termed
an “epidemic of survival” [5], is embodied in the establishment of the Office of Cancer Survivorship, at the
National Cancer Institute, initiated under the direction of
yet another prominent pediatric oncologist—Dr. Anna
Meadows—who has properly asserted that “continued
surveillance of childhood cancer survivors is good medicine” [6].
But who will rise to meet these challenges? In a recent
report, Oeffinger et al. [7] describe the results of their
survey of member institutions of the Pediatric Oncology
Group and the Children’s Cancer Group. Barriers to effective long-term care were compounded by lack of
“multidisciplinary transition programs,” for which positive experience exists in other disease entities [7]. The
operation of long-term follow-up (“late effects” or “after
care”) clinics remains largely the province of children’s
hospitals, staffed predominantly by pediatric oncologists
and nurse practitioners.
At least half of the adult survivors of cancer in childhood and adolescence do not avail themselves of such
services [7], suggesting a considerable need for education of this at-risk population and the community of
health care providers. Furthermore, the opportunities for
research in this population abound. It has been proposed
that, in addressing these and related issues, cancer societies could and should play an important role in stimulating research and assisting support activities [8].
In the context of industrialized societies, Dr. Archie
Bleyer has presented evidence that, when expressed as
the number of person-years of potential life saved, malignant diseases in the young rank second only to breast
cancer [1]. As the cure rate for cancer in childhood and
adolescence now approximates 70% overall [9] in these
societies, so there is an increasing need to give voice to
© 1999 Wiley-Liss, Inc.
the advocates of pediatric oncology, including the population of long-term survivors—a role for which MPO is
particularly well placed.
Issues such as access to after care, provision and costs
of services, education and interventional strategies [10],
outcomes research, and a host of others that focus on this
special population provide fertile ground for discussion
and study. By publishing the proceedings of the biennial
international conferences on late effects in survivors of
cancer in childhood [11], MPO has laid claim to this
topic as an editorial priority. The journal wishes to expand its coverage of these topics through publication of
articles pertaining to these areas of public health. They
include cancer control measures for adolescents, the special needs and concerns of adolescents who have cancer,
and the status of adult survivors of cancer in childhood
and adolescence. In so doing, MPO will encourage submissions from medical and pediatric constituencies alike
and thereby contribute to the resolution of the challenges
facing a burgeoning sector of our general population.
Ronald D. Barr,
MB, ChB, MD, FRCP(Glasg), FRCP,
McMaster University
and Children’s Hospital
Hamilton Health Sciences Corporation
Hamilton, Ontario, Canada
1. Bleyer WA. The impact of childhood cancer on the United States
and the world. CA Cancer J Clin 1990;40:355–367.
2. Blatt J. Studying survivors of childhood cancer for late effects of
therapy. Int J Pediatr Hematol Oncol 1995;2:325–336.
3. Hawkins MM, Stevens MCG. The long-term survivors. Br Med
Bull 1996;52:898–923.
4. Bradlyn AS, Ritchey AK, Harris CV, et al. Quality of life research
in pediatric oncology: research methods and barriers. Cancer
5. Van Eys J. The truly cured child? Pediatrician 1991;18:90–95.
6. Meadows AT. Curing cancer in children: minimizing price, maximizing value. J Clin Oncol 1995;13:1837–1839.
7. Oeffinger KC, Eshelman DA, Tomlinson GE, Buchanan GB. Programs for adult survivors of childhood cancer. J Clin Oncol 1998;
8. Haase GH, Mauer AM, Reaman GH. Survivorship in childhood
cancer. Cancer 1998;83:821–823.
9. Harras A, editor. Cancer rates and risks, 4th ed. Bethesda, MD:
National Cancer Institute; 1996.
10. Hudson MM, Tyc VL, Jayawardene DA, et al. The feasibility of
implementing health promotion interventions to improve healthrelated quality of life. Int J Cancer (in press).
11. Green DM, editor. Fourth International conference on long-term
complications of treatment of children and adolescents for cancer.
Med Pediatr Oncol 1998;1(Suppl):1–78.
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