Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers

Version 6.0 (October 2023)

The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG LTFU Guidelines) are a resource for healthcare professionals who provide ongoing care to survivors of pediatric malignancies. The screening recommendations in these guidelines are appropriate for asymptomatic survivors of childhood, adolescent, or young adult cancer presenting for routine exposure-based medical follow-up. More extensive evaluations are presumed, as clinically indicated, for survivors presenting with signs and symptoms suggesting illness or organ dysfunction. A basic knowledge of ongoing issues related to the long-term follow-up needs of this patient population is assumed. Healthcare professionals who do not regularly care for survivors of pediatric malignancies are encouraged to consult with a pediatric oncology long-term follow-up center if any questions or concerns arise when reviewing or using these guidelines. A complementary set of patient education materials, known as "Health Links" accompany the guidelines in order to enhance patient follow-up visits and broaden the application of these guidelines. More detailed information regarding development and application of the COG LTFU Guidelines and related materials is available by accessing the documents below.

Although the information within the guidelines will certainly prove valuable to the survivors themselves, the only version currently available is targeted to healthcare professionals. Therefore, survivors who choose to review these guidelines are strongly encouraged to do so with the assistance of a healthcare professional knowledgeable about long-term follow-up care for survivors of childhood, adolescent, and young adult cancers.

New to Version 6, a comprehensive guidelines document with appendices is available with links to ease document navigation.

Click below to download the interactive Complete COG LTFU Guidelines and Appendices, Version 6.0:
COG Long-Term Follow-Up Guidelines - Comprehensive (Guidelines - Appendix I - Appendix II)

Click below to download the COG LTFU Guidelines and Appendices, Version 6.0:
COG Long-Term Follow-Up Guidelines
Appendix I (Materials for Clinical Application)
Appendix II (Entire Set of Health Links)

Click below to download the following clinical tools:
Summary of Cancer Treatment (Abbreviated)
Summary of Cancer Treatment (Comprehensive)

Click below to download individual Health Links:  


COG Long-Term Follow-Up Program
Resource Guide

This comprehensive guide is designed for institutions interested in establishing and enhancing long-term follow-up programs for childhood cancer survivors. Developed collaboratively by the Children’s Oncology Group Nursing Discipline and Late Effects Committee, over 50 individuals from multiple disciplines contributed to this Guide, providing a broad perspective from a variety of long-term follow-up programs within the Children’s Oncology Group.

Click here to download a free PDF copy of the COG LTFU Resource Guide

General and Psychosocial:
Nutrition and Physical Activity (English) (Spanish)
School after Treatment (English) (Spanish)
Mental Health (English) (Spanish)
Finding and Paying for Healthcare (English) (Spanish)
Introduction to Long-Term Follow-Up (English) (Spanish)
Vaccination for HCT patients (English) (Spanish) (French)
Vaccination for non-HCT patients (English) (Spanish) (French)

Dental Health (English) (Spanish) (French)
Osteoradionecrosis (English) (Spanish)

Cardiac System:
Heart Health (English) (Spanish)
Cardiovascular Risk Factors (English) (Spanish)

Endocrine System:
Central Adrenal Insufficiency (English) (Spanish)
Growth Hormone Deficiency (English) (Spanish) (French)
Hyperprolactinemia (English) (Spanish)

Directory of Long-Term Follow-Up Services

The Children’s Oncology Group maintains a directory of long-term follow-up programs at COG-affiliated institutions. Click here to access the COG Late Effects Directory of Services.

Hypopituitarism (English) (Spanish)
Precocious Puberty (English) (Spanish) (French)
Thyroid Cancer (English) (Spanish)

Gastrointestinal System:
Gastrointestinal Health (English) (Spanish)
Hepatitis (English) (Spanish)
Liver Health (English) (Spanish)

COG Long-Term Follow-Up Guidelines Archive Files

Version 1.0 Guidelines
Version 1.1 Guidelines Appendix
Version 1.2 Guidelines Appendix
Version 2.0 Guidelines Appendix I Appendix II
Version 3.0 Guidelines Appendix I Appendix II
Version 4.0 Guidelines Appendix I Appendix II
Version 5.0 Guidelines Appendix I Appendix II
App II Chinese TC App II Chinese SC
Immune System:
Splenic Precautions (English) (Spanish) (French)

Musculoskeletal System:
Amputation (English) (Spanish)
Bone Health (English) (Spanish)
Limb Sparing Procedures (English) (Spanish)
Osteonecrosis (English) (Spanish)
Scoliosis and Kyphosis (English) (Spanish)

Neurological System:
Chronic Pain (English) (Spanish)
Peripheral Neuropathy (English) (Spanish)
Raynaud’s Phenomenon (English) (Spanish)

Passport for Care
Cancer Survivor Website Now Available

Featuring a COG LTFU Guidelines Generator
and Links to Cancer Survivor Resources

To learn more, visit:

Pulmonary System:
Bleomycin Alert (English) (Spanish)
Pulmonary Health (English) (Spanish)

Reproductive System:
Ovarian and Reproductive Health (English) (Spanish)
Testicular and Reproductive Health (English) (Spanish)

Cataracts (English) (Spanish) (French)
Eye Health (English) (Spanish) (French)
Hearing Loss (English) (Spanish)

Subsequent Neoplasms:
Breast Cancer (English) (Spanish) (French)
Colorectal Cancer (English) (Spanish)
Reducing Subsequent Cancers (English) (Spanish)
Skin Health (English) (Spanish)

Urinary Tract:
Bladder Health (English) (Spanish)
Cystectomy (English) (Spanish)
Kidney Health (English) (Spanish)
Neurogenic Bladder (English) (Spanish)
Single Kidney Health (English) (Spanish)

COVID-19 Information for Cancer Survivors:
COVID-19 (English) (Spanish) (French)

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All content posted above are the property of the Children's Oncology Group. All rights reserved worldwide.

The Children’s Oncology Group grants permission to download the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (including Appendices, Materials for Clinical Application, and Health Links) from www.survivorshipguidelines.org and to print copies for individual and institutional use, as long as the following conditions are met: (1) Copies are not sold or distributed for commercial advantage, and (2) the Children's Oncology Group copyright and its date appear on the printed copies.

Disclaimer and Notice of Proprietary Rights:

Introduction to Late Effects Guidelines and Health Links: The "Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers" and accompanying "Health Links" were developed by the Children's Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
For Informational Purposes Only: The information and contents of this website (including all text and graphics), the information and contents of each document or series of documents posted on this website or containing the title "Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers " or the title "Health Link", whether available in print or electronic format (including any digital format, e-mail transmission, or download from the website), shall be known hereinafter as "Site Content". All Site Content is for informational purposes only. The Site Content is not intended to substitute for medical advice, medical care, diagnosis or treatment obtained from a physician or health care provider.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition and do not rely on the Site Content. The Children's Oncology Group is a research organization and does not provide individualized medical care or treatment.
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