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		Finishing the Treatment
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Finishing the Treatment

All treatment programmes incorporate a planned end point, at which time treatment is ceased if disease has continued to be in remission (controlled). The timing of this event depends on the individual characteristics of each disease and each patient. However, we standardise the correct duration of therapy for groups of patients that we recognise to share certain characteristics. The details and explanations as well as the particular plan for each patient will be discussed in a conference.

For most treatment programmes certain tests are performed at the end of therapy to ensure that no residual disease is detectable at that time. A programme is then worked out for regular checks to follow and visits to the clinic or local doctors as appropriate for each family's circumstances. The contact between you, your doctor and the health care team will be continued in the same manner as described and practiced whilst on therapy. You may, however, see less of us and certainly have less procedures and complications to deal with. Many of the precautions, such as those related to infection risk, gradually diminish once the patient is not receiving chemotherapy. However, precautions regarding measles and chickenpox will apply till at least one year from the end of treatment. At that time it is also appropriate to recommence the immunisation programme from wherever it was up to prior to diagnosis.

Given that patients and families become accustomed to regular visits and treatment, it is sometimes difficult to progress into the next stage, that is being off treatment whilst still requiring regular monitoring. Importantly, the access to the members of the health care team is in no way reduced. The risk of disease recurrence or possible side effects will be discussed for each individual at the time of the conference. Further questions will arise as time goes by and, particularly, as children get older. It is essential that these questions are asked and that areas of concern are discussed whenever necessary.

The end of treatment is a positive event regardless of the type of cancer. While the risk of relapse or recurrence depends entirely on the individual cancer and subtype concerned, that risk is generally less after cessation of treatment than during treatment. Furthermore, should relapse or recurrence occur after cessation of therapy, chances of second remission are significantly higher than for the same event occurring while still on the treatment programme. The frequency and type of tests for "off-treatment monitoring" are tailored for each individual according to the risks and possible areas where disease might recur. These need to be explained and discussed as appropriate.

As time goes by and the risk of relapse becomes lower and lower, our emphasis shifts more to monitoring and correcting possible late side-effects of therapy. For these reasons visits continue indefinitely and become annual in the later stages. During our annual "long term follow-up clinics" we are particularly concerned with monitoring growth, development, education, job opportunities, reproductive function and other possible late side-effects of the treatment. The approach to total care for the family and patient continues to be as relevant when treatment is ceased as it is at the time of diagnosis.

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