Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study.
OBJECTIVE
To evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy.


METHODS
We conducted a cross-sectional survey of health care use in 8,522 participants in the Childhood Cancer Survivor Study, a multi-institutional cohort of childhood cancer survivors. We assessed medical visits in the preceding 2 years, whether these visits were related to the prior cancer, whether survivors received advice about how to reduce their long-term risks, and whether screening tests were discussed or ordered. Completion of echocardiograms and mammograms were assessed in patients at high risk for cardiomyopathy or breast cancer. We examined the relationship between demographics, treatment, health status, chronic medical conditions, and health care use.


RESULTS
Median age at cancer diagnosis was 6.8 years (range, 0 to 20.9 years) and at interview was 31.4 years (range, 17.5 to 54.1 years). Although 88.8% of survivors reported receiving some form of medical care, only 31.5% reported care that focused on their prior cancer (survivor-focused care), and 17.8% reported survivor-focused care that included advice about risk reduction or discussion or ordering of screening tests. Among survivors who received medical care, those who were black, older at interview, or uninsured were less likely to have received risk-based, survivor-focused care. Among patients at increased risk for cardiomyopathy or breast cancer, 511 (28.2%) of 1,810 and 169 (40.8%) of 414 had undergone a recommended echocardiogram or mammogram, respectively.


CONCLUSIONS
Despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.
Nathan
Paul C
PC
Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada, paul.nathan@sickkids.ca
Greenberg
Mark L
ML
Ness
Kirsten K
KK
Hudson
Melissa M
MM
Mertens
Ann C
AC
Mahoney
Martin C
MC
Gurney
James G
JG
Donaldson
Sarah S
SS
Leisenring
Wendy M
WM
Robison
Leslie L
LL
Oeffinger
Kevin C
KC
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D016017:Odds Ratio; D011839:Radiation, Ionizing; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
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