E-poster Presentation 2014 World Cancer Congress

Establishing paediatric long term follow-up transition clinics in the tertiary adult health care sector (#623)

Susan Skinner 1 , Ruth Harrap 1 , Karen Egan 1 , Jane Williamson 1 , Peter Downie 1
  1. Paediatric Integrated Cancer Service, Parkville, VIC, Australia

Background and Context:

The number of new patients referred to the Paediatric Long Term Follow-up (LTF) Program, in addition to existing LTF patients requiring ongoing review, exceeds current clinic capacity.


The Long Term Follow-up Program (LTFP) collaboratively established transition clinics with two tertiary adult health care providers to support the process of transition and to enhance transfer of adolescent/young adults (AYA) to the tertiary adult health care sector.


In the three years (36 months) prior to June 2012, 14 patients were transitioned to tertiary adult health care providers (an average of 4.6 patients per year). Transition clinics were implemented in July 2012. In the period July 2012 to December 2013 (18 months) a total of 28 patients have been transitioned to tertiary adult health care providers (an average of 18.7 patients per year). An additional 15 patients are planned for transition by June 2014 (an average of 21.5per year).

Programme/Policy Process:

The Long Term Follow-Up Program now has a clear process in place to support the potentially difficult period of transition for survivors of childhood cancer to the appropriate tertiary adult health care centre.

Outcomes/What was learned:

Following the implementation of formalised transition clinics, transition of AYA’s to tertiary adult health services has increased to 7% of all patients referred to the LTFP. Transition has increased from 5 patients per annum to 22 patients per annum, creating capacity within the LTFP for new referrals and reducing waiting list times. The implementation of formalised transition clinics supports AYA patients receiving a personalised and supported transition, reduces the numbers of AYA patients ‘bouncing back’ to the paediatric sector, and provides the opportunity for the adult health care sector to receive an in-depth ‘face to face’ hand over of these complex patients.