Abstract：
Rates of childhood cancer survival in developed countries have risen to over 80-85 %. In consequence, the population of childhood cancer survivors (CCS) has grown considerably. Nevertheless, CCS present a high morbidity and mortality due to cancer or its treatment, with an increased risk of premature mortality, second primary tumors and late side effects, both physical and psychosocial, all of which decrease the quality of life. Long-term follow-up (LTFU) of CCS is recommended to prevent, detect and treat those health problems. Despite the advances achieved, the management of CCS is still not optimal. Among the areas for improvement discussed in this manuscript are: (1) Quantifying the real burden of morbimortality, by implementing new frequency measures (mean cumulative count and cumulative burden), to obtain more accurate assessments, and using simulation models, to determine individual risks; (2) Assessing the impact of risk factors for late side effects, related to the patient, tumor type, treatments, lifestyle, comorbidities, genetics and ageing; (3) Considering the impact of the international harmonisation of long-term follow-up guidelines, to generate homogeneous, evidence-based recommendations and an individualized LTFU and, (4) Challenges to LTFU implementation, considering models of care adapted to patient risk and needs, with special attention to the transition to adult-care follow-up. Finally, we comment on the situation of CCS in Spain and consider future prospects for improving the health and quality of life of this population.
摘要：
发达国家的儿童癌症存活率已经上升到80-85%以上。因此，儿童癌症幸存者（CCS）的数量已大大增加。然而，由于癌症或其治疗，CCS具有很高的发病率和死亡率，过早死亡的风险增加，第二原发肿瘤和晚期副作用，身体和社会心理，所有这些都降低了生活质量。建议对CCS进行长期随访(LTFU)以预防,发现并治疗这些健康问题。尽管取得了进展，CCS的管理仍然不是最优的。本手稿中讨论的改进领域包括：（1）量化病态的实际负担，通过实施新的频率测量(平均累积计数和累积负担)，为了获得更准确的评估，并使用仿真模型，确定个别风险；(2)评估风险因素对晚期副作用的影响，与病人有关,肿瘤类型,治疗,生活方式,合并症,遗传学和老龄化；(3)考虑到国际协调长期后续指南的影响，为了产生同质的，基于证据的建议和个性化的LTFU，(4)LTFU实施面临的挑战，考虑到适应患者风险和需求的护理模式，特别关注向成人护理随访的过渡。最后,我们评论西班牙CCS的情况，并考虑改善该人群健康和生活质量的未来前景。
