| *1. How does your institution provide
follow-up care for childhood cancer survivors?
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Answer:(2)Followed in SPECIALIZED PROGRAM for survivors of childhood cancer
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| |
| *2. What is the age cut-off for providing
follow-up care to childhood cancer survivors at your institution?
|
Answer:
(2)Patients seen up to 18 years of age
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| |
*3. Please provide phone numbers (as
applicable) for referral of long term follow-up patients to your Institution.
(If not available, enter "None"):
|
| Appointments: |
Answer:613-737-2470
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| General information: |
Answer:613-737-2470
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| New LFTU patient referrals: |
Answer:613-737-2470
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| Comments: |
Not Answered
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| |
| *4. If your institution does not provide life-long
follow-up care for childhood cancer survivors, please describe where the
patient is referred for long term follow-up when age limitation is reached:
|
Answer:
(3)Specialized program for ADULT survivors of childhood cancer
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| |
| If your institution has a specialized long-term follow-up program for
childhood cancer survivors, please complete the following information: |
| 5. Program name: |
Answer:After Cancer Treatment (ACT) Clinic
|
| 6. Program director: |
Answer:Dr. Karen Mandel
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| 7a. Program coordinator: |
Answer:Pat McCarthy CNS
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| 7b. Program coordinator: |
Answer:Anna Zietak RN
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|
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| *8. What are the eligibility criteria for survivors
entering your program?
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| Answer: |
2 years off therapy
Bone marrow transplant patients are eligible
Neuro-oncology patients are eligible
|
|
| |
| *9. Do you offer late effects
consultations to survivors who were not treated at your institution?
|
Answer:
Yes
|
| |
*10. What information is required for
a patient being referred from an outside facility to your program?
|
| Answer: |
Health care provider referral letter
Medical Records
|
|
| 11. If your institution has a specialized adult follow-up program,
please provide the following information:
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| Program name:
|
Answer:Transition Clinic for Survivors of Childhood Cancer
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| Program director:
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Answer:Dr. Laval Grimard
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| Program coordinator:
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Answer:Pat McCarthy CNS
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*12. Who provides the long-term follow-up
care for your adult survivors of childhood cancer?
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| Answer: |
Pediatric Oncologist
Pediatric Nurse Practitioner
Other
Radiation Oncologist
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