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Most US children diagnosed with cancer now survive, but life comes at a price - later cancers, heart disease and learning disorders, according to a report issued recently.

Parents, doctors and the cancer survivors themselves need a clear set of guidelines so they know what to look for as the years pass, an expert committee at the Institute of Medicine said in the report.

"Success in treating disease has been tempered by the knowledge that the cure has often came at a price, which may not be manifest until many years after completion of therapy," the report reads.

"As many as two-thirds of childhood cancer survivors are likely to experience at least one late effect, with perhaps one-fourth of survivors experiencing a late effect that is severe or life threatening."

The Institute of Medicine, one of the National Academies of Sciences, advises the federal government on matters of health and medicine.

"What happens is for several reasons kids are not followed properly in many cases after they complete their therapy," Dr. Joseph Simone, a retired pediatric oncologist who chaired the panel, said in a telephone interview.

"Once the chance of recurrence has dissipated, perhaps the family doesn't want to go back to an environment that has bad memories, children get to be adolescents and say 'I don't want to go back to that children's place', families move ... so there is no structure naturally for them to go to," added Simone.

"And we can't expect primary care doctors to take on this responsibility without some form of guideline, really some form of road map to follow."

The panel called on the National Cancer Institute to put together the guidelines so they could be widely available.

They could be long and complex, because a patient's health risks depend on what kind of cancer they had as children and what treatment they got.

For instance, leukemia survivors risk learning disabilities, heart problems, hepatitis C from blood transfusions, obesity and osteoporosis.

Brain cancer survivors need to be watched for learning disabilities or other neurologic effects, hearing loss, kidney damage, infertility and vision problems.

"We have to consider cancer in children, the ones who survive, a chronic disease now," Simone said.

As of 1997, there were 270,000 survivors of childhood cancer of all ages in the United States.

"This translates to about 1 in 640 adults between ages 20 to 39 years," the report reads.

Pediatric cancer once was a death sentence but treatment methods have brought the overall survival rate up to 78 per cent.

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