Late effects and long-term follow-up in survivors of childhood and adolescent cancer

The survival rates for childhood and adolescent cancer have improved significantly over recent decades, with the five-year survival now exceeding 80% in many regions. However, cancer therapies, while lifesaving, are associated with late effects, or health complications that emerge months to years after treatment. These effects, which include physical, psychological, and cognitive issues, affect over 60% of survivors and often persist or worsen with age. Common late effects involve the cardiovascular, endocrine, and musculoskeletal systems, as well as neurocognitive impairment, infertility, and the risk of subsequent malignancies. Long-term follow-up (LTFU) care is critical for identifying and managing these conditions. Risk-based, individualized LTFU can enhance survivors’ health awareness, promote timely interventions, and improve quality of life. Guidelines from international organizations like PanCare and the International Guideline Harmonization Group support structured, evidence-based care pathways. Nurse-led models for the organization of LTFU are emerging as effective and patient-centered approaches within multidisciplinary teams. Despite its importance, LTFU participation remains suboptimal. Survivorship care plans and improved communication may help increase engagement. As therapies evolve, personalized follow-up strategies based on treatment history and risk profiling will be essential. This narrative review article explores the prevalence and burden of late effects; highlights the role of LTFU; and examines future directions for optimizing survivorship care in childhood and adolescent cancer survivors.