Nobody owns the follow-up once the oncology clinic lets go

The transplant facet named this one precisely: there is a published list of what should be done, an inspected standard for the programmes that should do it, and registries that record outcomes, and there is no mechanism in either country that reliably tells an individual survivor, ten years out and living two hundred miles from the transplant centre, which tests they are due this year.

The same failure appears on every facet. After childhood cancer the largest survey of its kind concluded that despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care; among physicians, half felt confident providing survivorship care and 94 per cent had unmet information needs about survivors' late-effect risks. After transplant the commonest failure in revaccination is a handover gap: the transplant centre assumes the general practice will do it, the general practice assumes the centre has. After anthracyclines, surveillance echocardiography is often not arranged once a survivor leaves paediatric care, and blood pressure, the most treatable determinant of whether a survivor develops heart failure, is routinely not measured at a cancer follow-up appointment. Survivors frequently do not have their radiotherapy fields and doses recorded anywhere they can reach, which makes a risk-based guideline unusable even where someone is willing to follow it.