LATER outpatient clinic

Why is the LATER outpatient clinic necessary?

Given that the number of childhood cancer survivors has increased, long-term side effects have emerged. These side effects deserve attention. It is known that 70% of all childhood cancer survivors develop one or more serious health issues. This is precisely why we have a team of experts at the Princess Máxima Center that regularly performs check-ups on survivors. In addition to this medical care, other important areas of interest of the LATER outpatient clinic include social and psychological care in combination with contact with fellow patients.

What is the LATER outpatient clinic?

If you have had cancer as a child or teenager, it is important that you are monitored and receive proper aftercare. Basically, you remain under medical care for the rest of your life. There is a special outpatient clinic for your check-ups, namely the LATER clinic of the Princess Máxima Center in Utrecht. All children with cancer have been treated at this Center since June 2018. Our aim is to cure every child with cancer, with maximum quality of life. Consequently, our care does not stop when treatment ends. At the LATER outpatient clinic, both children and adults from all over the country are examined for late effects of childhood cancer treatment. All knowledge and expertise in the field of these late effects is centralized in the LATER outpatient clinic. At the LATER clinic we can detect and treat late effects in an early stage, sometimes even before any complaints arise.

When will you be summoned?

Everyone who qualifies for the LATER outpatient clinic will be called up for an appointment. This is standard procedure and no cause for alarm. How often you are called up for a check-up depends on the type of cancer and the treatment you have had. It varies from once a year to once every five years.

What can you expect from a check-up appointment?

When you come to the LATER outpatient clinic an appointment has been arranged for you with the doctor who is interested to know how you are doing. The doctor will tell you more about possible late effects that may occur as a result of your disease history and treatment and will also perform a number of standard physical examinations. After your appointment with the doctor, you will often be referred for additional tests, such as a blood test, urine test, lung function test and/or an ultrasound of the heart. These tests are preferably scheduled on the same day. Which tests the doctor requests also depend on your specific situation and the treatments you have had. If necessary, the doctor can also refer you to other healthcare providers, such as another medical specialist, but also a psychologist if needed.

Are any costs associated with a visit to the LATER outpatient clinic?

Visits to the LATER outpatient clinic are reimbursed by the health insurers. A deductible applies as from the age of 18.

Scientific research at the LATER outpatient clinic

In order to continue to improve the treatment of childhood cancer, we also conduct scientific research in the LATER outpatient clinic. You might therefore be asked to participate in a research project. We will discuss this with you in advance and you will also receive an information letter. Participation in scientific research is voluntary and not mandatory.

Frequently asked questions about the corona virus

I have had cancer as a child, am I extra susceptible to the virus?
Survivors with specific late effects (eg from the heart or lungs) may experience more complaints. An international guideline with recommendations specific to child cancer survivors, based on data known in the general population, has recently been drawn up. The English version can be found here.

It also remains important to follow the RIVM guidelines:
• Stay at home with symptoms of cough, if you have a cold or a fever. Limit social contacts.
• Even if you have no complaints, work at home as much as possible or try to spread your workings hours.
• Wash your hands with water and soap regularly.
• Cough and sneeze on the inside of your elbow.
• Use paper tissues.
• No handshakes

For more information, we refer you to www.RIVM.nl and www.vokk.nl

If you have complaints, follow the RIVM guidelines: https://www.rivm.nl/en/novel-coronavirus-covid-19/questions-and-answers#personalhealth

Do you have a fever or difficulty breathing? Contact your own doctor. If you have any questions about whether you can go to work, please contact your own doctor and/or the company doctor.

Does your doctor or specialist have specific questions about your situation? They can contact us at (088) 9727272 or (088) 9725051.

If you still have questions about your personal situation, please contact the LATER-clinic: (088) 9727272 of (088) 9725051.

My LATER clinic appointment is canceled. When will I be able to come again?
The LATER clinic of the Princess Máxima Center has been temporarily closed and will gradually start again from May 11th. The LATER clinic will contact you for a new appointment.

What is the LATER outpatient clinic?

Growing numbers of children with cancer recover thanks to improved treatment and care. There are currently more than 12,000 people in the Netherlands who have had cancer as a child. Research shows that survivors are more likely to suffer health problems than their peers. Sometimes these late effects do not occur until years after treatment. Many late effects are treatable, especially if caught early.

That is why you are regularly invited to visit the LATER outpatient clinic. How often you should come depends on your diagnosis and treatment. This can vary from once a year to once every five years.

All knowledge about late effects is amassed in the LATER clinic. Our LATER care is based on scientific research and years of experience. Consequently, you get the care you need.

When do you visit the LATER outpatient clinic?

As from five years after being diagnosed, you will be expected at the LATER outpatient clinic for a check-up. Up to the age of 18, you will see either your own or another pediatric oncologist or LATER pediatrician. Once you turn 18, you will be seen by a LATER doctor for adults, a clinical nurse specialist. Around the time of turning 18, a smooth transfer to the LATER outpatient clinic for adults is arranged, and the check-ups with the pediatric oncologist cease. That can take some getting used to.

During your first meeting, the LATER outpatient clinic and your personal LATER care plan is explained to you. The frequency of your check-ups and which examinations will apply depend on the type of cancer and the treatment you have had. The latter determine the risk of late effects. Your check-ups can continue on an annual basis, but also once every two and a half or five years.

Receiving an invitation

You will receive an invitation for each LATER visit containing the date, time, place and the planned examinations. We strive to conduct all your examinations and your interview on the same day.

If you received treatment at the Princess Máxima Center, we have all your details. If you were registered at another LATER outpatient clinic, your details have been transferred to the Princess Máxima Center. The LATER outpatient clinic of the Princess Máxima Center is in fact a combination of the LATER outpatient clinics of:

the AMC (Amsterdam)
the ErasmusMC (Rotterdam)
the UMCG (Groningen)
the UMCU (Utrecht)
the VUMC (Amsterdam)

There are also LATER outpatient clinics in the LUMC (Leiden) and the Radboudumc (Nijmegen). If you go to either one of those clinics for your check-ups, you can address any questions you might have to them.

If you have been waiting for a while for an appointment or if you want to know when you are scheduled, please contact us so we can make an appointment for you if you wish.

Who pays for the LATER check-ups?

Visits to the LATER outpatient clinic are covered by insured care and are reimbursed by your health insurer. If you are 18 years or older, you are subject to the compulsory deductible. When considering increasing your deductible, keep your LATER check-ups in mind.

How to get to the LATER outpatient clinic

If coming by public transport, get off at the Princess Máxima Center (WKZ/Prinses Máxima Centrum stop). If coming by car, you can park in the Princess Máxima Center's parking garage. Your number plate is scanned, so there is no need for a ticket. To pay for your parking, enter your license plate in the parking machine.
You can go straight to the LATER outpatient clinic. It is located on the ground floor, to the left of the espresso bar.

Your visit to the LATER outpatient clinic

How to prepare for your visit. What to take along, where to go. When do you get the results? This information is provided below.

What to take along

Remember to bring your ID with you. If you take medication, it is useful to bring a list of your medicines along. It is also handy to bring something along to keep you busy if you have to wait for a while.
In the waiting area there is a reading table and a cabinet containing information brochures, and you can pour yourself a cup of coffee, tea and/or chocolate milk. If you have to wait a bit longer, you can go to the restaurant, the espresso bar or the gardens.

What is the procedure?

After entering through the swing doors, first report to the doctor's assistant who checks your identity, address and general practitioner details. Together you go over the place and time of your scheduled check-ups. Your blood pressure, height and weight are then taken in room 1 or 2.
You meet with the LATER doctor/clinical nurse specialist, you are given a physical examination and, if necessary, additional examinations. During this meeting you can ask questions and discuss any physical complaints and other problems. The LATER doctor/clinical nurse specialist also asks you about your health, studies, work, friends and your thoughts about your treatment period and whether it still affects your life. They also ask what you know about possible late effects, fertility and so on.
A psychologist, a fertility nurse specialist and physiotherapists are attached to the LATER outpatient clinic and work together with specialists from the UMCU/WKZ, such as a cardiologist (heart), lung specialist, endocrinologist (hormones), gynecologist and rehabilitation specialist. You are informed of who you are to see and why.

Where to go

You will be collected in the waiting area for the interview, blood taking and examinations, such as a heart ultrasound, lung function examination and hearing test.
Report to the doctor's assistant after every interview or examination so that they can keep track of your schedule.
Due to the distance to get to some examinations or because of possible delays, it is not possible to schedule all examinations consecutively. If time allows, you can visit the restaurant, the espresso bar and the gardens.
Blood is drawn at the LATER outpatient clinic. Let the doctor's assistant know if you are afraid of needles or if you have difficult veins.
Heart ultrasound, lung function test and hearing test are also conducted at the LATER outpatient clinic, as is the interview with a LATER doctor, clinical nurse specialist, psychologist or physiotherapist.
Examinations such as an MRI or ultrasound are conducted in the Princess Máxima Center. Other examinations, such as a mammography, MRI or DEXA scan, are done in the UMCU, which is about a 20 minute walk away. The doctor's assistant will give you directions. If this is too far for you or if you don't want to go to the examination alone, the doctor's assistant can arrange for a wheelchair and a volunteer to accompany you.

When do you get the results?

About two weeks after your LATER visit, you have a telephone appointment with the LATER doctor or clinical nurse specialist, who goes through the results with you and answers your questions.

If the results deviate slightly, your doctor can conduct further examinations. Then, if abnormalities are still detected, we usually refer you to a specialist in a hospital in your area. In some instances we refer you to a specialist who has extensive knowledge regarding late effects.

In the event of abnormal results, we sometimes call you up for a LATER check-up at an earlier point in time than usual.

After your LATER visit, we send your GP and any other specialists a letter containing the results and advice.

You are automatically called up for your next visit to the LATER outpatient clinic.

The patient portal

You can view your medical file by logging into the patient portal with your DigiD.

Should you have any questions about the contents of the file, please contact the LATER doctor/clinical nurse specialist.

Why is the LATER outpatient clinic necessary?

What is the LATER outpatient clinic?

Your visit to the LATER outpatient clinic

When do you get the results?

The patient portal

More information

Team LATER outpatient clinic