Long Term Follow-up in Childhood

Cancer Survivors in Serbia

Vesna Ilic, MD, PhD

Pediatric oncologist
Institute for Oncology and Radiology of Serbia/National Cancer Research Centre
Pediatric Oncology
Centers in Serbia
Population 7 million, 1.4 million pediatric (<19 years old)

Approx. 300 newly diagnosed childhood cancer patients per

year

5 centers participating in diagnosis, treatment and follow up

• Institute for Oncology and Radiology of Serbia, Belgrade (50-60 pts/year)
• University Children Hospital “Tirsova”, Belgrade (60-65 pts/year)
• Institute for Mother and Child, Belgrade (45-60 pts/year)
• Clinical Center Nis (30 pts/year)
• Institute for Child and Youth Healthcare, Vojvodina-Novi Sad (20-30
pts/year)
Childhood Cancer Treatment in Serbia
IORS-the only center in Serbia where pediatric radiotherapy is applied

IORS-this center is also the only institution in the country (and parts of the region) treating children
with brain tumors and bone sarcomas

The high-dose therapy and hematopoetic stem cell transplant -done only at the Institute for
Mother and Child

Other centers treat mainly hematological malignancies

Patients undergoing surgical treatment only are treated and followed at the institution where
surgery was performed (e.g. patients with low grade gliomas)
 LTFU in Serbia
Most childhood cancer institutions in Serbia (except of the Institute for Oncology and
Radiology) follow their patients until they are 19 (the end of high-school). After that,
these patients are referred to adult medical oncologists for further follow up

Patients are followed in accordance with treatment protocol recommendations,

depending on the treatment modalities/intensity and expected treatment adverse
effects

Exact percentage of childhood cancer survivors attending LTFU visits is unknown

LTFU at the Institute for Oncology and
Radiology of Serbia
The only center in Serbia providing follow up for patients even in adulthood

Brain tumors and bone sarcoma treatments frequently result in severe long-term adverse effects, life-time
dissabilities including delayed psycho-motor development, difficulties in performing usual acivities of daily
living and self-care,endocrine sequelae,ototoxycity

Team of in-house pediatric oncologists, skilled and educated nurses, psychologists, physiotherapists,
radiotherapists and surgeons provide treatment, but also a guidance and support related to treatment long
term adverse effects

Pediatric oncologist is in the centre of a referral network for LTFU activities required to be performed outside
of the institution
The Central Role of Pediatric Oncologist in LTFU

Late Effects in Childhood Cancer

Survivors
Neuro- Organs, tissues, and body function
psychological
Support

Growth and development

Nephrotoxicity Ototoxicity

Mood, feelings, and actions

Pediatric
Oncologist

Thinking, learning, and memory

Physical
Cardiotoxicity
Treatment

Social and psychological adjustment

Endocrinology
& Reproductive
health
Risk of second cancers
Cancer Survivors LTFU in Serbia
Pediatric Cencer Survivors face unique health challenges that require care from multidisciplinary
team of providers with expertise in survivorship
Unfortunately, there are no specialized/structured clinics for survivor follow up in Serbia. All follow
up activities are embedded in the existing network of pediatric cancer centers, with pediatric
oncologist in the center of the referral system, coordinating majority of follow up activities
This type of facility would greatly help this population in timely follow up activities, recognozing
unique medical needs and specific treatment-related long-term effects, facilitating daily living,
education and seamless transition from childhood to adulthood

No specific funding for LTFU. All follow up activities are covered by Public Health Insurance

There’s insufficient number of health care providers in pediatric oncology in Serbia

Parental/Survivor Society

• There are 4 active sociaties

• NURDOR (National Association of Parents of Children with Cancer)
• Zvoncica
• Cika Boca & Mladice
• Uvek sa Decom
Main goals are psychological and social support, help in achieving legal rights,
providing the best possible conditions in hemato-oncology departments, educating
the parents, children, medical staff, volunteers and the public, support in handling
late effects after cancer tretment.
Goals and Expectations

• Insuring optimal long-term person-centred care recognizing risk factors for each patient bearing in mind
that risk of late effects largely depends on the type of treatment, the genetic and hereditary background and
lifestyle, and remains high lifelong
• Improving quality of life of children even after their cancer treatment, during their growth and transition to
adolescents and adults
• Supporting and educating survivors and their families about possible late effects at the end of oncology treatment
could decrease burden to society healthcare consumption and could lead to prevention of complications
• How?
• Participate in treatment and decision making
• Investigate-what are the late effects, be supportive of a research
• Develop guidelines and then follow and update
• Stay in touch with colleagues, share knowledge, spread awareness
• Be visible
• Get $
Thank you