08 January 2014

Adult survivors of childhood cancer have special needs

A survey of internists found that most physicians were not comfortable caring for adult survivors of childhood cancer.

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.

Special needs

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.

Read: Child 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% or higher.

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.

Read: Explaining cancer to your child

Appropriate recommendations

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 patients.

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 guidelines.

Transition to primary care

Part of the problem can be laid at the feet of the paediatric oncologists who saved these kids, Henderson said.

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 treatment.

"We need to be doing a better job as oncologists of transitioning these patients to primary care," Henderson said.

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