Most pediatric cancer survivors poorly followed
CHICAGO (Reuters Health) - Data from the Childhood Cancer Survivor Study indicate that the majority of long-term survivors of childhood cancer do not receive the recommended follow-up care, despite the fact that they have a significant risk of developing late side effects of cancer therapy, including heart disease and secondary cancers.
"There is a definite need to educate physicians and childhood cancer survivors about the importance of long-term risk-based follow-up care," Dr. Paul C. Nathan of the Hospital for Sick Children, Toronto, said at the annual meeting of the American Society of Clinical Oncology.
Nathan and colleagues surveyed 8,522 adult survivors of childhood cancer about the health care they received in the previous 2 years. Their average age at the time of cancer diagnosis was 6.8 years - and the average age at the time of the survey was 31.4 years.
Less than one third (32 percent) of those surveyed reported having a visit in the last 2 years with a doctor or nurse who was involved with their previous cancer care.
Only 18 percent said they received risk-based cancer-related care -- meaning the doctor or nurse discussed ways they could reduce their cancer-related risk or had ordered or discussed certain screening tests. Twelve percent had not seen a doctor or nurse for any reason in the preceding 2 years.
Among patients with significantly increased risk of heart disease or breast cancer due to cancer treatment received in childhood, only 28 percent reported receiving an echocardiogram and 49 percent reported having a mammogram, respectively, Nathan reported.
"We were disappointed by these findings," Nathan said. "Only a minority of patients receive recommended screening tests for heart problems and breast cancer."
Adult survivors of childhood cancer at greatest risk for not receiving follow-up care are the uninsured, males, and patients with lower household incomes.
What breastcancer.org says about this article…
Most pediatric cancer survivors poorly followed
If you have been treated earlier in life for cancer, this story is worth your attention. In recent decades, some of the most important triumphs in cancer care have been in the treatment of childhood cancer. But with that success has come a price for some childhood cancer patients who later develop a second cancer or another serious medical condition believed to be related to their earlier cancer treatment.
For example, the radiation used to treat or cure a childhood cancer can also affect normal cells exposed to the radiation, causing a new, different cancer that develops many years later. Because of this risk, people who have been treated for cancer in the past should be more aggressive about doing what they can to minimize their risk of another cancer. These individuals should also have regular screenings for possible complications of their earlier treatment, including the development of another cancer, such as breast cancer. The researchers in this study found that former childhood cancer patients were, on average, NOT getting the kind of medical care, counseling, and screening (including mammograms) that they should based on their medical history. Perhaps not surprisingly, those who had lower incomes or who were uninsured were least likely to get appropriate follow-up care.
If you've been treated in the past for cancer, it's particularly important that you regularly see a doctor who is familiar with your past medical history, understands your special risks, and who can plan with you and provide to you the counseling, monitoring and screening for possible complications of your prior treatment. If your past treatment history increases your risk of breast cancer, you and your doctor should consider a more aggressive approach to breast cancer screening. This kind of approach might include more frequent mammograms starting at an earlier age than the normal recommendation of age 40, and perhaps using different imaging techniques, such as breast MRI.
This article was made possible by an educational grant from GlaxoSmithKline.
