Intended for healthcare professionals

Practice Guidelines

Long term follow-up of survivors of childhood cancer: summary of updated SIGN guidance

BMJ 2013; 346 doi: (Published 27 March 2013) Cite this as: BMJ 2013;346:f1190
  1. W H B Wallace, professor of paediatric oncology 1,
  2. L Thompson, programme manager2,
  3. R A Anderson, professor of clinical reproductive science, University of Edinburgh3
  4. on behalf of the Guideline Development Group
  1. 1Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
  2. 2Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland, Edinburgh EH12 9EB, UK
  3. 3MRC Centre for Reproductive Health, University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
  1. Correspondence to: W H B Wallace hamish.wallace{at}

Cancer is diagnosed in 1600 children each year in the United Kingdom, and for teenagers cancer is the leading cause of death after accidents (unintentional injury, including road traffic incidents). The five year survival rate has improved over recent decades, from 30% to 80%; this increased survival has led to a rapidly increasing population of adult survivors, with an estimated 33 000 childhood cancer survivors now living in the UK.1 These survivors have higher premature death rates than the general population and are at increased risk of a range of physical and psychosocial problems.2 Late effects of treatment may occur soon after the treatment ends or many years later.

Healthcare practitioners need guidance about potential late effects and the lifelong needs of survivors of childhood cancer. This article summarises the most recently updated recommendations from SIGN.3


SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (figure), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”), based on the clinical experience of the Guideline Development Group, is also indicated (as GPP). The group appraised the current evidence for new or completely revised sections on subsequent primary cancers, fertility, cardiac and bone health, and metabolic effects; for the remaining sections the group did not re-appraise the original supporting evidence.

Fig 1 Explanation of SIGN grades of recommendations

Subsequent primary cancers (all new recommendations)

  • Be aware that survivors of childhood cancer are at particular and lifelong increased risk of developing a subsequent primary cancer (C).

  • As those who have been treated with radiotherapy are at risk of subsequent primary cancer arising within the radiation field, adopt a high level of awareness when assessing health concerns (C). The risk of a subsequent primary …

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