The St. Jude Children's Research Hospital After Completion of Therapy Clinic

The St. Jude's After Completion of Therapy (ACT) Clinic was established in 1984 to address the needs of long-term survivors treated at St. Jude Children's Research Hospital. Survivors eligible for transfer to ACT Clinic include those treated at St. Jude who are cancer-free, 5 years from diagnosis (5 years after completion of relapse therapy), and 2 years after completion of therapy. Services provided to clinic attendees include transportation, housing, and medical care costs not covered by insurance. The clinic's mission is to improve the quality of life of survivors by facilitating their access to resources that optimize physical and emotional health, social functioning, and educational and vocational achievement. ACT evaluations are undertaken by a multidisciplinary team comprised of nurses, advanced practice providers, physicians, social workers, psychologists, and other medical subspecialists as needed. ACT interventions include the organization of a survivorship care plan/treatment summary, risk-based health screening, counseling about health risks/risk mitigation, comprehensive psychosocial assessment, assistance with care transitions, and case management for identification of local resources. The ACT Clinic offers educational opportunities to graduate medical trainees and precepts national and international visitors seeking guidance in the development of survivorship programs. The ACT Clinic also provides a robust infrastructure for research investigations that have aimed to characterize health outcomes in long-term survivors and test interventions to prevent/remediate adverse effects of childhood cancer and its therapy. Findings from research facilitated by the ACT Clinic have informed health surveillance recommendations for long-term survivors and guided interventions to promote healthy aging among this growing population. Implications for Cancer Survivors This review describes a model of care that addresses the medical and psychosocial challenges of survivorship while integrating research investigations to improve health outcomes among childhood cancer survivors.