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Survivorship surveillance schedules, indexed by exposure

Q: Which guideline should a primary-care clinician default to for adult survivors of childhood cancer?

COG Long-Term Follow-Up Guidelines v6.0 is the most complete exposure-indexed source. Use ASCO guidance for adult-onset cancers and cardiac dysfunction, and IGHG for harmonized international surveillance recommendations on specific late effects.

Q: How often should echocardiography be repeated after anthracyclines?

Most schedules run every two years for cumulative doses under 250 mg/m² and annually at or above that threshold, or when chest radiation was also given. Any new dyspnea, reduced exercise tolerance, or edema moves imaging forward regardless of interval.

Q: Do these schedules require access to the treatment record?

They require the exposure summary: regimens, cumulative doses, and radiation fields with doses. A survivor can bring that on a one-page printable transition plan, which is why the plan matters more than chart access.

Q: Is this page a substitute for clinical judgment or the source guidelines?

No. It is a navigation layer that points to the primary source for each recommendation. Confirm details against the linked guideline and apply your own judgment to the individual survivor in front of you.

Start from what the survivor received, not from the diagnosis. Each row gives the threshold that matters, what to watch, how often, and the guideline behind it. Nothing here needs a chart pull or a login.

Search exposures

12 of 12 exposures shown

Anthracyclines (doxorubicin equivalent)

Threshold: Any dose; risk rises above 250 mg/m²
Watch: Echo with LVEF + global longitudinal strain, symptom review
Interval: Baseline at entry to survivorship, then every 2 years (<250 mg/m²) or every year (≥250 mg/m² or chest RT)

COG LTFU v6.0 · ASCO cardiac dysfunction guideline

Chest / mantle radiation

Threshold: ≥15 Gy to a field including the heart
Watch: Echo, valve assessment, lipid panel, ischemia symptom review
Interval: Every 2 years from 5 years post-RT; add stress imaging at 10 years

COG LTFU v6.0 · AHA cardio-oncology statement

Trastuzumab / HER2-directed therapy

Threshold: Any exposure; higher with prior anthracycline
Watch: LVEF, symptom review; consider strain in prior-anthracycline patients
Interval: Every 3 months on therapy; at 6 and 12 months after; then symptom-driven with a low re-imaging threshold

ASCO cardiac dysfunction guideline

Immune checkpoint inhibitors

Threshold: Any exposure; combination therapy highest
Watch: Troponin, ECG, symptom cluster (dyspnea, myalgia, palpitations)
Interval: Highest risk in the first 12 weeks, but late presentations occur; check troponin and ECG on any new cardiac or myositis symptom regardless of interval since last dose

Chest RT in a female treated before age 30

Threshold: ≥10 Gy
Watch: Breast MRI plus mammography
Interval: Annually beginning at age 25 or 8 years post-RT, whichever is later

IGHG breast-cancer surveillance

Neck / craniospinal radiation

Threshold: Any dose to thyroid or HPA axis
Watch: TSH, free T4, thyroid exam; growth and pubertal markers in younger survivors
Interval: Annually, indefinitely

IGHG endocrine surveillance

Alkylating agents (cyclophosphamide, ifosfamide, busulfan)

Threshold: Cyclophosphamide equivalent dose ≥4 g/m²
Watch: Gonadal function: FSH/LH, estradiol or testosterone, AMH where relevant; fertility counseling
Interval: At entry to survivorship and on any fertility or pubertal concern

IGHG gonadotoxicity · ASCO fertility preservation

Bleomycin, busulfan, chest RT

Threshold: Any exposure
Watch: Pulmonary function tests including DLCO; ask about exertional dyspnea
Interval: At entry to survivorship, then symptom-driven; repeat before general anesthesia or high-FiO₂ exposure

COG LTFU v6.0

Cisplatin / carboplatin, ifosfamide, abdominal RT

Threshold: Any exposure
Watch: Creatinine with eGFR, electrolytes including magnesium, urinalysis; audiometry for platinum
Interval: Annually for the first 5 years, then every 2-3 years if stable

COG LTFU v6.0

CNS-directed therapy (cranial RT, intrathecal methotrexate)

Threshold: Any exposure
Watch: Neurocognitive screen; school or workplace accommodation review
Interval: At entry to survivorship, and at each educational or occupational transition

IGHG neurocognitive surveillance

Total body irradiation / HSCT

Threshold: Any conditioning regimen
Watch: Metabolic panel, lipids, HbA1c, bone density, thyroid, gonadal, cataract exam, revaccination status
Interval: Annually, with a revaccination series starting 6-12 months post-transplant

COG LTFU v6.0 · transplant late-effects consensus

Abdominal / pelvic radiation

Threshold: ≥30 Gy to bowel
Watch: Colonoscopy
Interval: Every 5 years beginning 10 years post-RT or at age 30, whichever is later

IGHG · NCCN Survivorship

Exposure	Threshold	What to watch	Interval	Source
Anthracyclines (doxorubicin equivalent)	Any dose; risk rises above 250 mg/m²	Echo with LVEF + global longitudinal strain, symptom review	Baseline at entry to survivorship, then every 2 years (<250 mg/m²) or every year (≥250 mg/m² or chest RT)	COG LTFU v6.0 · ASCO cardiac dysfunction guideline
Chest / mantle radiation	≥15 Gy to a field including the heart	Echo, valve assessment, lipid panel, ischemia symptom review	Every 2 years from 5 years post-RT; add stress imaging at 10 years	COG LTFU v6.0 · AHA cardio-oncology statement
Trastuzumab / HER2-directed therapy	Any exposure; higher with prior anthracycline	LVEF, symptom review; consider strain in prior-anthracycline patients	Every 3 months on therapy; at 6 and 12 months after; then symptom-driven with a low re-imaging threshold	ASCO cardiac dysfunction guideline
Immune checkpoint inhibitors	Any exposure; combination therapy highest	Troponin, ECG, symptom cluster (dyspnea, myalgia, palpitations)	Highest risk in the first 12 weeks, but late presentations occur; check troponin and ECG on any new cardiac or myositis symptom regardless of interval since last dose	ASCO immune-related adverse events guideline
Chest RT in a female treated before age 30	≥10 Gy	Breast MRI plus mammography	Annually beginning at age 25 or 8 years post-RT, whichever is later	IGHG breast-cancer surveillance
Neck / craniospinal radiation	Any dose to thyroid or HPA axis	TSH, free T4, thyroid exam; growth and pubertal markers in younger survivors	Annually, indefinitely	IGHG endocrine surveillance
Alkylating agents (cyclophosphamide, ifosfamide, busulfan)	Cyclophosphamide equivalent dose ≥4 g/m²	Gonadal function: FSH/LH, estradiol or testosterone, AMH where relevant; fertility counseling	At entry to survivorship and on any fertility or pubertal concern	IGHG gonadotoxicity · ASCO fertility preservation
Bleomycin, busulfan, chest RT	Any exposure	Pulmonary function tests including DLCO; ask about exertional dyspnea	At entry to survivorship, then symptom-driven; repeat before general anesthesia or high-FiO₂ exposure	COG LTFU v6.0
Cisplatin / carboplatin, ifosfamide, abdominal RT	Any exposure	Creatinine with eGFR, electrolytes including magnesium, urinalysis; audiometry for platinum	Annually for the first 5 years, then every 2-3 years if stable	COG LTFU v6.0
CNS-directed therapy (cranial RT, intrathecal methotrexate)	Any exposure	Neurocognitive screen; school or workplace accommodation review	At entry to survivorship, and at each educational or occupational transition	IGHG neurocognitive surveillance
Total body irradiation / HSCT	Any conditioning regimen	Metabolic panel, lipids, HbA1c, bone density, thyroid, gonadal, cataract exam, revaccination status	Annually, with a revaccination series starting 6-12 months post-transplant	COG LTFU v6.0 · transplant late-effects consensus
Abdominal / pelvic radiation	≥30 Gy to bowel	Colonoscopy	Every 5 years beginning 10 years post-RT or at age 30, whichever is later	IGHG · NCCN Survivorship

Questions clinicians ask about these schedules

Which guideline should a primary-care clinician default to for adult survivors of childhood cancer?

COG Long-Term Follow-Up Guidelines v6.0 is the most complete exposure-indexed source. Use ASCO guidance for adult-onset cancers and cardiac dysfunction, and IGHG for harmonized international surveillance recommendations on specific late effects.

How often should echocardiography be repeated after anthracyclines?

Most schedules run every two years for cumulative doses under 250 mg/m² and annually at or above that threshold, or when chest radiation was also given. Any new dyspnea, reduced exercise tolerance, or edema moves imaging forward regardless of interval.

Do these schedules require access to the treatment record?

They require the exposure summary: regimens, cumulative doses, and radiation fields with doses. A survivor can bring that on a one-page printable transition plan, which is why the plan matters more than chart access.

Is this page a substitute for clinical judgment or the source guidelines?

No. It is a navigation layer that points to the primary source for each recommendation. Confirm details against the linked guideline and apply your own judgment to the individual survivor in front of you.

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Guidelines move. If an interval, threshold, or source link is out of date, flag it and a clinical reviewer will look at it. Please do not include any patient information.