Improved treatment of
childhood cancer has led to an unprecedented health care problem, with primary
care physicians unprepared to care for the special medical needs of adult
cancer survivors, researchers report.
A survey of internists –
primary care doctors for adults – found that most physicians were not
comfortable caring for adult survivors of childhood cancer.
Most also were unfamiliar
with the special needs these patients have because of their cancer treatment,
according to findings published in the Annals of Internal Medicine.
cancer survivors at risk
For example, only 12% of
the internists surveyed felt at least "somewhat familiar" with health
screening guidelines for childhood cancer survivors.
"These patients need
special health care throughout their lifetime, focused on screening and
prevention," said co-author Dr Tara Henderson, director of the Childhood
Cancer Survivors Centre at the University of Chicago Medicine Comer Children's
Hospital. "This tells us there's a gap we need to address to improve the
health of these patients."
In a way, it's a problem
that cancer doctors are happy to have. Back in the 1950s, fewer than half of
kids survived childhood cancer, Henderson said. These days, the cure rate is 80%
Chronic health problems
Currently, more than 350 000
childhood cancer survivors live in the United States, and the number continues
to grow, the authors note.
But the treatments that
helped save these kids also put them at long-term risk of chronic health
problems. For example, chemotherapy or chest radiation treatment can increase a
child's lifetime risk of heart disease.
"We've given these
patients increased cardiac risk factors, so we need to make sure primary care
physicians are paying attention to these patient's health behaviours and
providing the appropriate screening," Henderson said.
Henderson and her team sent
out a survey to which 1 110 general internists responded, asking questions
about the care of childhood cancer survivors.
cancer to your child
Between 25% and 37% said
they would be at least "somewhat comfortable" caring for a childhood
cancer survivor. Their responses varied based on the type of cancer the patient
had, the researchers reported.
When asked about screening
guidelines for childhood cancer survivors, most physicians did not know the
guidelines well enough to make an appropriate recommendation for their
Only 9% understood that
women exposed to chest radiation as children need annual mammography and breast
MRI scans. More than 40% said they weren't sure of the guidelines.
Just 15% knew that
childhood chemotherapy patients need an echocardiogram every other year to
check for heart problems. More than half said they would not proceed with
further echocardiograms, and another 19 percent said they weren't sure of the
Transition to primary care
Part of the problem can be
laid at the feet of the paediatric oncologists who saved these kids, Henderson
The survey found that
nearly three-quarters of internists who have cared for an adult survivor of
childhood cancer never received a summary detailing their patient's cancer
"We need to be doing a
better job as oncologists of transitioning these patients to primary
care," Henderson said.
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