Adolescent leukaemia care: planning transfer to adult services

Moving from a paediatric leukaemia service to an adult team should leave the young person with a known clinician, a current care plan and a clear next appointment. Reaching an age boundary is an administrative event; the handover must also preserve the treatment history and the support that makes care manageable.

Distinguish a service change from a treatment change

A transfer may happen during ongoing treatment or years later during follow-up. State which situation applies at the start of the referral. If therapy is continuing, the adult team needs to understand the actual protocol and current phase. If active treatment has ended, it needs the treatment summary and the follow-up responsibilities already agreed.

Ask explicitly whether any proposed change is a clinical recommendation or simply a change in where care is delivered. Moving departments does not explain, by itself, why a medicine, investigation or follow-up arrangement would change. The young person should not have to infer the reason from a different appointment letter.

Prepare a record the next team can use

Keep the diagnosis, treatment dates, important complications and latest assessments together. Where available, include the formal treatment summary produced by the paediatric team rather than trying to calculate exposures from old prescriptions. Record who holds missing information and how the adult service can request it.

Add the current medicines, allergies and unresolved questions. If another specialty is involved, specify its role and next planned review. A folder containing every historic result is less useful without a short explanation of which issues remain active now. The guide to preparing a concise medical history can help the family organise that explanation while retaining the originals.

Give the young person a practical role

Transition guidance emphasises preparation, a coordinated handover and support after transfer. Ask for an opportunity to meet the adult team and to discuss how communication will work. The young person should be included directly, with the support or interpreter they need, and asked how they want parents or carers involved.

Make responsibilities concrete. Who books the next test? Where do appointment messages go? Can the young person explain the current medicine list, or is help still needed? These are matters to solve together, not a test of whether someone is mature enough to deserve care.

Discuss education, work or living away from home where they affect appointments and daily treatment. If the young person prefers part of the consultation without relatives, ask the service how that can be arranged. Plans should respect the applicable consent rules and the person’s communication needs without assuming that family involvement must suddenly stop.

Do not leave a gap between the last and first appointments

Before the final paediatric visit, obtain the adult service’s acceptance, first appointment details and urgent contact arrangements. Ask which team remains responsible until the new service takes over. If an appointment is missed or cancelled, there should be a known route to re-establish care rather than a return to the start of a referral process.

For a move involving Turkey, check the receiving centre’s actual age pathway and clinical experience with the required care. Age thresholds and service organisation differ; an arrangement described in English guidance is not a promise about a Turkish hospital. The two clinical teams should agree the handover directly.

Keep a copy of the final agreed plan with the young person and the chosen supporters. The aim is continuity with increasing participation and appropriate help, not a birthday-driven change that leaves important decisions or symptoms without a responsible team.

Sources

• NHS England: Supporting young people to transition into adolescent and adult services