**8. Long-Term survivors or better "cured" subjects: After treatment, long-term follow-up**

How well are the children responding to the increasingly successful treatments? Programs oriented to the needs of the long-term survivor should begin when the child goes off therapy, with centers focusing on the sequelae specific to each form of illness, treatment, toxicity, and future problems specific to each child's needs. Centers should offer counseling programs for the more serious medical and psychosocial problems, adapted to the need of each individual and local culture. Centers should develop specialty clinics, managed by the pediatric oncologist who treated the children, and having available a full range of adult and young adult specialists as consulting physicians. Each long-term survivor should be monitored for special conditions related to their unique history as well as their age-specific developmental concerns. Programs should include psychological counseling for the survivors experiencing adjustment difficulties and significant side effects.

As medicine continues to achieve an increasingly higher success rate in long-term survival, we should follow survivors to determine further potential long-term sequelae. The longterm role of each pediatric hematology/oncology center is to follow the survivors until there is assurance that the child will have no further long-term sequelae. It is important and critically necessary to follow the child until the disease is considered "cured" (at about five years). After that time, one should not over-medicalize the survivor, but help the child to make the transition to normal health-care status. When specific sequelae (such as heart problems) are known for a particular child, that child should be followed for the issue of concern specific to that child.

The clinic should keep a careful computerized record of essential data particular to each survivor so that in the future, when the now-adult survivor is seen by an adult physician, the data on the survivor's previous cancer experience will be available upon request.

Psychological research studies that have followed the survivors of childhood cancer for many years after successful treatment have found, not only that the now-adult-survivors are doing well, but that in many way having learned from the challenges of their childhood cancer experience they are better prepared for the more pressing challenges of adulthood than are their peers. The so-defined resilience is not an utopia but a always more visible reality.
