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The treatment of childhood cancer has been increasingly successful over the past 30 years. Most paediatric cancers are now curable with multiagent chemotherapy in combination with surgery and radiotherapy. The overall survival five years after diagnosis is now 70% for all paediatric malignancies. The incidence is low (1200-1300 children affected each year in Britain), but with the sustained improvement in survival the number of long term survivors is increasing—about 850 additional survivors of childhood cancer each year. With this improved survival, it is important to increase our knowledge of any long term costs in the form of physical and psychosocial adverse health outcomes. This review looks at the evidence relating to long term clinical follow up after childhood cancer and considers ways to develop such follow up for the future. An awareness of the possible long term complications is important not only for optimising health care for the current survivors but also for modifying future treatment protocols to avoid therapies that are associated with unacceptable morbidity or mortality. We have summarised the evidence on selected long term complications; this evidence is inevitably based on retrospective studies. In the final section we discuss the development of a strategy for the clinical follow up of long term survivors. #### Summary points Long term follow up strategies are needed because of increasing numbers of survivors of childhood cancers Models for follow up need to be developed and formally evaluated Increasing numbers of survivors may have medical problems that will require ongoing specialist follow up The role, training programmes, and career structure of the late effects nurse practitioner needs to be developed The primary care physician may have an important role in long term follow up There is a need for prospective evaluation of new treatments and randomised studies of clinical interventions to resolve substantial uncertainties for …

Background: To evaluate a clinic based intervention designed to improve attitude to follow-up, increase self-efficacy or confidence to care for health, and raise awareness of possible vulnerability to future health issues among survivors of childhood cancer. The intervention included an information booklet, treatment summary and separate information sheets, which were explained to survivors as part of routine follow-up care. Procedure: Survivors (n=263; mean age=21 years; >5 years since diagnosis) attending one of seven United Kingdom Children's Cancer Study Group (UKCCSG) late-effects follow-up clinics completed questionnaires before and after the intervention. Outcome measures included self-ratings of importance of follow-up, readiness to change behaviour, self-efficacy, perceived vulnerability, and ratings of informativeness and emotional content of the written material. Results: Responders were more likely to be female than non-responders, held more positive views about the importance of follow-up and perceived themselves to be more vulnerable to health risk. After the intervention, responders reported that they were more prepared to change their behaviour, had increased self-efficacy, but also perceived themselves to be more vulnerable to future health problems. Conclusions: We conclude that the intervention is a relatively simple way to enhance awareness among survivors about the importance of follow-up and need for vigilance in their healthcare. Difficulties in recruiting survivors who failed to attend are considered.