BACKGROUND: The issues involved in transition from pediatric cancer care to adult-focused care differ from those in other childhood diseases, because malignant disease itself is no longer a problem. However, the potential for fatal outcome places a greater dependence on the pediatric oncology setting and delays this transition process, often beyond adolescence. Adverse long-term physical and psychological effects accompany survival for many of the cured children, and because these effects may not become manifest until adulthood, programs that support transition for childhood cancer survivors require the expertise of many subspecialists. OBJECTIVES: To describe the issues and barriers to successful transition programs for childhood cancer survivors when they are ready for adult-focused care. METHODS: We reviewed the literature and discuss the barriers to transition at the survivor, provider, and health care system levels for survivors of childhood cancer. We also critically assess the elements of successful transition programs. RESULTS: Education of survivors and providers regarding long-term health risks is necessary for a successful transition. This process should be gradual to address the educational needs of survivors, families, and health care professionals, determine "readiness" for transition, and address financial and insurance concerns. Because little is known regarding adverse long-term health-related sequelae beyond the fourth decade of life, research is needed to quantify and reduce the consequences of these morbidities. CONCLUSIONS: Transition programs for pediatric cancer survivors require experts who are knowledgeable regarding the long-term follow-up needs of childhood cancer survivors and who can provide a bridge between pediatric oncology and primary care that is risk based.