Implications for follow-up and long-term care
Today, not enough is known about the challenges facing adolescents and young adults with a history of childhood cancer, or about the strategies they may use to effectively 
address them, or about the programmes and interventions that may effectively increase knowledge about cancer and its treatment, empowerment, self-confidence and coping.
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This is in part due to the fact that follow-up care for young adult survivors of paediatric and adult-onset cancers is not consistently provided in the same setting in which they receive their cancer treatment. Oeffinger et al. report that ‘few programs focus on the long-term health care needs of adult survivors of childhood cancer. The majority of existing programs are in pediatric institutions, without significant input from adult-oriented, generalist health care providers’. Oncology professionals must consider where and when as well as how best to deliver interventions that will meet the needs of a young, developing and geographically mobile population. We need to proactively empower and prepare survivors during their treatment through the teaching of advocacy skills and we may need to bring follow-up intervention to the client, or at least provide it in settings appropriate and conducive to their needs.
Harvey et al. suggest that comprehensive and quality follow-up for long-term cancer survivors should include education in previous diagnosis, treatment Cialis in Canada online and potential late effects, with an emphasis on wellness, health maintenance and health promotion. Fertility assessment, including evaluation of survivors’ knowledge about their own reproductive capacity, and counselling should become part of that comprehensive follow-up. Young adult survivors, as well as the health and welfare professionals who care for them, may benefit from timely information and health education regarding present and future fertility, options for having a family, sexual behaviour and risks for adverse outcomes such as unplanned pregnancy or exposure to sexually transmitted diseases (STDs).
As these young people age, the transition from being patients to off-treatment survivors and the taking on of new and additional responsibilities as they establish independence mean they will be faced with making their own life decisions. An important issue for adolescent and young adults is the decision of if, when and how to share information about cancer with their peers. An even more delicate issue is what and how much to say about their illness to new acquaintances and particularly to those with whom a long-term intimate relationship may be possible. Faced with the potential for varied reactions, young people with cancer may lose confidence because of their uncertainty about whether and how they will be accepted.
When loss of opportunities for social interaction with peers is severe, it is experienced as a major deprivation that multiplies other stresses of the illness. When positive interaction with peers occurs, it helps ease such stresses and renews young people’s adaptive capacities. Given that peer socialization and relationships are of great importance and concern to this young population, those who promote an advocacy framework for support are faced with the challenge of developing a skill set that will help survivors deal with stigmatization by peers and maintain friendships/relationships.