If you met 12 year old Natalie Smith, so full of life, you would have no hint of what she has conquered.
"In 2006 I was diagnosed with acute myelogenous leukemia, or cancer of the blood. And I underwent eight rounds of chemotherapy, about a year of treatment," Natalie revealed.
But the treatment only stopped the disease for a time. She relapsed and in 2008 she needed more chemotherapy, then radiation, and in the end, a bone marrow transplant.
"The whole experience I can barely remember, except for really really small parts of it, I can remember perfectly," Natalie said.
But her mother realized that the end of cancer treatment was just a first step.
"She's at very high risk of secondary cancers," said Dene James.
But Natalie is no longer surrounded by her cancer care team. It can be a frightening time for a family.
"They need us to go back to our pediatrician and resume our normal life. But we're still not sure about all those aches and pains," said James.
So she enrolled Natalie in the Seattle Children's Cancer Survivor Program. She'll be monitored throughout childhood. Her parents get specific information to share with Natalie's pediatrician.
"It mentions the chemotherapies, the radiation, any surgeries she might have had," said James as she leafed through Natalie's personalized summary.
"(It's) a summary of the treatment that the patient received. But then it's a care plan, and a roadmap for what that patient needs in the future," explainedDr. Scott Baker, of Fred Hutchinson Cancer Research Center.
Dr. Baker is director of the program for Seattle Children's and Seattle's Cancer Care Alliance.
"What really becomes scary to the patients and families is the risk of recurrence," he said.
The program's clinic staff is able to catch a recurrence at the earliest stage. They also screen for other late health effects from radiation and chemotherapy. Those health impacts include heart disease learning problems and kidney disease.
"Chemotherapy can affect bones and impact the way that they grow, as well as affect the brain and central nervous system," Dr. Baker said.
Natalie recently had confusing symptoms including dry skin and hair loss. Staff at the clinic soon pinpointed a cause. Natalie's cancer treatments had damaged her thyroid. She needed to be on medication.
"I wouldn't have been thinking about the thyroid but they knew immediately," said Dene James.
Participation in the program gives the family the reassurance they need to worry less about the cancer in Natalie's past, and to plan for her health for a lifetime.
Since cancer treatments can also affect a child's ability to learn, the clinic staff often works with school teachers and counselors to customize a child's education plan.