Childhood cancer survival rates have increased significantly in the last 30 years. While the remarkable successes and increasing cure rates of childhood cancer treatments are celebrated, there can be can impacts on normal physiological and psychological growth and development. When young age and intensity of treatments are taken into consideration, childhood cancer survivors may experience complex and sometimes debilitating health problems into adulthood. The “late effects” of childhood cancer can include but are not limited to psychosocial issues, fertility and endocrine problems, as well as cardiovascular, renal and lung dysfunction, the concept of “frailty”, and the diagnosis of a second cancer. It is imperative that we understand the risks of certain long term effects in relation to treatment related exposure (surgery, radiation, stem cell therapies, immune and targeted therapies, and chemotherapy) as well as socioeconomics, demographics, and pre-morbid conditions unrelated to the diagnosis of cancer. In addition, increasing knowledge about each patient’s genetic make-up is helping to shape more individualised treatment; predicting the ability of drug and radiation tolerance can help develop treatment protocols, and reduce the risk of treatment related morbidity. Improved awareness in relation to cancer causing syndromes and genetics (familial and somatic) should lead to improved screening, and conceivably lead ultimately to childhood cancer prevention. The development and implementation of the Victorian Childhood Cancer Outcomes Registry is key to data gathering, analysis, prediction of potential future health problems, and information for holistic health care, as the child transitions to adult care. The ultimate goal is to achieve better long term outcomes for our future generations of childhood cancer survivors.