Survivors of childhood cancer, having overcome the biggest hurdle to a normal life span, must continue to be vigilant toward health care issues as well as toward certain psychological and social problems for which they are at a greater than normal risk. The long-term survivor's knowledge about his/her illness, its treatment, and the consequent need for health surveillance and maintenance practices must be continually updated. Equally important is the survivor's preparation for coping with any long-term consequences of disruption in family, academic, and social activities engendered by cancer treatment. Existing research has frequently focused on patients diagnosed in early childhood. Recent studies, however, suggest that the developmental disruptions may have special significance for the adolescent, who is already struggling with unique issues of separation, changes in peer relationships, emergent sexuality, and future academic and occupational goals. Previous investigations addressing the medical and psychiatric problems encountered by the long-term survivor of adolescent cancer are presented with a focus on current psychological adjustment and degree of emancipation achieved. A recent pilot study, from three major medical centers, collected extensive interview data on a group of long-term survivors and sibling controls. Preliminary analyses of these data are described, and areas for future research are suggested.
Cancer 58529-533, 1986.
HE ABSOLUTE NUMBER of long-term survivors (LTS)
T of childhood cancer is increasing at a truly remarkable rate. This represents major advances in surgery, radiation therapy, and chemotherapy treatment programs.
Surviving the disease itself, however, does not necessarily signal an end to the difficulties and stresses faced by these young patients and their families. The late medical sequelae of cancer and its treatments can be frightening and restrictive, and the financial burdens incurred during treatment can be prohibitive, extending beyond the time of illness. Equally significant are the alterations in lifestyle, relationships, future plans, and intrapsychic equilibrium consequent to living with a life-threatening disease.
Continuing Stressors
Understanding of the long-term consequences of cancer first requires an appreciation of the impact of the disease at the time of diagnosis and active treatment. The problems encountered by the pediatric cancer patient and his family during this period have been well-documented over