Transition of childhood cancer survivors from pediatric to adult care system

Introduction
Late effects of anticancer treatment during childhood could develop when the patient is under the medical care of adult specialists. Therefore, it is relevant to provide the interdisciplinary system of long-term follow-up for every childhood cancer survivor transitioning to adults.

Aim of the Study
To evaluate methods and process of transition to adults performed among patients treated for neoplastic diseases in the childhood in all pediatric oncology departments in Poland.

Material and methods
Data were obtained from pediatric oncology centers in Poland (n = 17) on the basis of the questionnaire, consisting of 20 questions that concerned on the method of transition.

Results
The study revealed that age of children being informed about long-term side effects of the antineoplastic treatment is >10 years old (y.o.), most frequently at the beginning of the treatment (in 16 centers), then repeatedly at the end of the treatment in 12 departments (70%), and finally before transition to adults - in 15 centers (88%). Final education is performed by leading doctor (11/17), leading doctor with psychologist (5/17), and doctor with psychologist and nurse (1/17). Pediatric follow-up finishes when survivor turns 18 y.o. in 9 centers; on the other hand, it is continued in 8 centers (but only in 4 above 21 y.o.). In 11/17 centers, transition to adults is one-time transmission; in the remaining departments, it lasts several weeks. In 10 departments, survivors are sent to the specialist only when the side effects occur during hospitalization; 7% of the departments provide specialists care before demonstration of complications. In 14 centers, follow-up is conducted by specialists and family medicine doctors, and in one department, only by primary care physician.

Conclusions
Our study indicates the lack of homogenous principles of transition to adults performed among young adults treated for neo¬plastic diseases in the childhood. Transition is mainly non-fluent, one-time procedure.The process does not prepare survivors to take the responsibility for their future life. Improving the methods of survivors medical care by organization of multidisciplinary clinics for adolescents and young adults and systematic,frequent education might ameliorate the quality of follow-up and improve the quality of life.