2016 Volume 53 Issue 5 Pages 448-452
Few reports refer to recent developments in the transition of pediatric malignant solid tumor survivors from pediatric to adult care. We investigated the long-term outcomes and challenges involved in this transition. The cases of 42 patients (21 male and 21 female subjects; age: ≥15 years) who visited our unit in 2004 were retrospectively reviewed. The courses of their treatment and care from 2004–2014 were reviewed. The diseases included neuroblastoma (11), Wilms tumor (10), germ cell tumor (6), hepatoblastoma (5), pancreatic tumor (5), and others (5). The follow-up levels and the number of patients for each level as per the Japanese guidelines were as follows: Level 1, 7; Level 2, 2; Level 3, 21; Level 4, 1; and Level 5, 11. Seventeen subjects were lost to follow-up, 11 transitioned to adult care, 9 continued under pediatric care, and 5 completed the treatment. Thirteen of those lost to follow-up were classified under Levels 3, 4, and 5, requiring continuous care. Among those who had transitioned, 9 were classified under Level 5 and had complications including renal failure, cardiac failure, hypertension, and viral hepatitis, requiring special treatment in adult departments. Most subjects under pediatric care were classified under Level 3 with no late effects and required no special treatment in the adult departments. The transition of patients classified under Level 3, who have no complications, is not smooth, and the loss of medical records is possible. An early education program and an effective transition system should be developed, especially for intermediate- to high-risk survivors.
