Surviving Childhood Cancer-What Next? Challenges In Developing Countries

9571 Background: Advances in treatment of childhood cancer have increased survival, frequently accomplished at cost of late effects. Curing more children without sequelae is a moving goalpost. Management of childhood cancers is difficult and is often guided by socioeconomic constraints in developing countries. Morbidity of late effects adds to burden of therapy. A need to address these issues was felt. Methods: Drawing inspiration from efforts at St. Jude Children's Research Hospital long-term follow-up clinic for survivors of childhood cancer, appropriately named, After Completion of Therapy (ACT) Clinic to emphasize that ACTs are needed beyond therapy to achieve CURE, was initiated at Tata Memorial Hospital in February 1991. Aims of clinic are to monitor growth, development, sexual maturation and somatic late effects of therapy and to apply corrective measures. Results: From Feb 1991 to Feb 2011, 1,190 survivors (off therapy and disease free for >2 years) have been enrolled in ACT clinic. Highlights of observations are 1) striking male preponderance (3:1) suggestive of preferential treatment to male child in our society. 2) Less frequent (9%) grade III sequel in survivors of hematolymphoid malignancies vis-à-vis. Solid tumours( 29%) highlighting need for organ preservation protocols. 3) Increased risk of death attributed to late recurrence and SMN emphasizing need for life long follow up. Conclusions: Our ACT model has attained 3 milestones: 1) Providing longitudinal care at a tertiary care center. 2) Ongoing communication with primary care provider ensuring continuity of follow-up. 3) Education and empowerment of survivors through voluntary support group, UGAM, sensitizing them towards need for continued surveillance, healthy lifestyle and becoming ambassador of the message “Childhood Cancer is Curable” in society. Clinical characteristic of 1,190 survivors. Median age at diagnosis 6 yrs. (0-19 yrs) Median time since diagnosis 9 yrs. (2-37 yrs) Median time since cessation of therapy 8 yrs. (2-35 yrs) Median duration of follow-up 4 yrs. (0-19 yrs) Grading of late effects: Normal 0 559 (46%) Abnormal lab report—no intervention I 227 (19) Simple intervention II 110 (90%) Complex intervention III 241 (20%) Life-threatening complications IV 63 (5%)