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Tijn about the LATER clinic: 'It reassures me that I can go there with questions'.

If you have had cancer as a child, you are under supervision at the LATER clinic of the Princess Máxima Centre. Tijn (20) was diagnosed with cancer when he was a freshman at 12 and now comes to this LATER outpatient clinic: 'I still have problems with painful hands and feet. The LATER doctor checks how these are doing and gives me advice.'

The name of the LATER outpatient clinic is derived from LAngeTERmine. At the LATER clinic, the occurrence of long-term effects of treatment for childhood cancer is examined. This expertise center at the Máxima Center ensures that children who have recovered from cancer receive good care and education. Close cooperation with the LATER research department improves future treatments for children with cancer.


As a 12 year old freshman, Tijn (20) was treated for Hodgkin lymphoma with various chemotherapy treatments, for six months. He continued to go to school as much as possible during the treatments; his school class was fun and provided a distraction. Tijn has the worst memories of certain chemotherapy treatments: He had a lot of pain in his hands and feet, later also in his back which caused him to end up in a wheelchair for a while. He still has these painful hands and feet, neuropathic pain, and these are so-called 'late effects' of his cancer treatment. He loves sports with friends and adapts his schedule to the pain. Tijn: 'I can't run very well but I can do sports on a cross trainer, for example. I also like to kick a ball around on the nearby field. And, he adds with a laugh, 'my painful hands have made my handwriting even worse than it already was.’


Soon Tijn will be going to the LATER clinic in the Princess Máxima Center: 'I like the LATER clinic, it reassures me that I can always go there with questions. I still suffer from late effects and the LATER doctor checks how I'm doing and gives me advice. Hopefully something will be found, a treatment or medication, that will get rid of the pain. Although I have really learned to deal with it well.' Tijn gets a kind of bonus: he stays with Dr. Andrica de Vries, the pediatric oncologist who once treated him but is now also a LATER doctor at the Princess Máxima Center.


Andrica de Vries, LATER specialist: ‘Before the outpatient appointment, the survivor fills out a questionnaire that I use to prepare for the outpatient visit. I then already know part of what's going on. During the visit, we discuss any specific questions, but I also talk about what we do at the LATER clinic, and why. In addition, I perform physical examinations. Certain guidelines have been established for other examinations, so when appropriate, a lab or ultrasound examination sometimes follows. For example an ultrasound of the heart, if the survivor has had certain chemotherapy. If necessary, I refer a survivor to another medical specialist or a psychologist.’


More and more children with cancer are cured thanks to better treatment and care. At this moment there are more than 12.000 people in the Netherlands who have had cancer as a child. Research shows that they have a higher risk of health problems. Sometimes these problems only arise years after treatment. With timely monitoring, many symptoms can be treated well. Andrica de Vries: 'Five years after a treatment for childhood cancer, a survivor is invited for the first time. This is now the case for Tijn. Depending on the treatment and the long-term effects present, a check-up takes place every year, every two years or every five years. The visit to the LATER clinic is part of the national guideline on follow-up for childhood cancer. Tijn sees his ‘own’ pediatric oncologist again at the LATER clinic and says: ‘Dr. de Vries once said, 'You can always call me.' When I get symptoms, I feel worried. I then think it could be cancer. That's why the LATER clinic is especially reassuring to me.’