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Child Cancer Survivors Overlooked

Most Survivors of Childhood Cancer Don’t Get Recommended Follow-Up Care
By
WebMD Health News
Reviewed by Louise Chang, MD

June 5, 2007 (Chicago) -- Although survivors of childhood cancer are at significant risk for long-term medical problems, less than one-third receive health care directed at addressing those risks when they are young adults, researchers report.

"Twelve percent of these patients receive no health care at all," says researcher Paul Nathan, MD, a cancer doctor at the Hospital for Sick Children in Toronto.

Male and poor or uninsured childhood cancer survivors are least likely to receive follow-up care, Nathan tells WebMD.

According to Nathan, nearly two-thirds of childhood cancer survivors develop one or more chronic health problems as they age. “In 28% of them, the condition is severe or life-threatening,” he says.

Breast Screen Underutilized

Nathan says he is particularly concerned about survivors at increased risk for heart problems or breast cancer.

One in five women who received chest radiation for childhood cancer will develop breast cancer before age 45, so current guidelines call for them to have a mammogram every year starting at age 25, a far younger age than recommended for most women. Yet the survey showed that fewer than half of such women received the recommended breast screening.

Similarly, up to half of childhood cancer survivors are at risk for heart disease, leading to guidelines that survivors at risk of cardiac disease have an echocardiogram (sonogram of the heart, which looks at heart chamber size and how well blood is pumping through the heart) every one to two years. But only 28% of the participants received the recommended echocardiograms.

About 1 in 3 Receive Cancer Follow-Up Care

For the study, Nathan and colleagues asked more than 17,000 people who had been diagnosed with cancer between 1970 and 1986 to fill out questionnaires about the type of health care they were receiving. Of the total, 8,522 agreed to participate. Their average age at time of cancer diagnosis was 7; their average age at the time they filled out the survey was 31.

Among the findings:

  • 32% of participants received health care related to their childhood bout with cancer.
  • Just more than half (56%) of the participants received general health care in which doctors performed routine examinations without asking about their cancer.
  • Only 18% of participants received so-called risk-based care designed to proactively address complications they are most likely to develop.
  • Survivors most likely to be given risk-based care were anxious, in pain or poor physical health, or suffering from a chronic condition like diabetes.

‘Tip of the Iceberg’

By nature of agreeing to participate, “these people are motivated, so the findings represent a best-case scenario," says Archie Bleyer, MD, medical advisor in the Cancer Treatment Center at St. Charles Medical Center in Bend, Ore. “This is the tip of the iceberg.”

Bleyer moderated a news conference at which the research was presented at the annual meeting of the American Society of Clinical Oncology.

Nathan says a lot of the problem is that many survivors don’t know what kind of treatment they received as children. Even if they do, he says, they often don’t know the long-term risks associated with the therapy.

“When their treatment is complete, they should have this information,” he says. If the information is not provided by the doctor, parents should request it.

Once they have the information, childhood cancer survivors, too, must be proactive, Bleyer says. Even though young adults may sometimes be reluctant to discuss details of their childhood, it crucial that survivors share that information with their doctors.

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