title: New health conditions identified at a regional childhood cancer survivor clinic visit.
abstract: BACKGROUND
  Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003-2009.
  
  
  METHODS
  A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines. The frequencies and associated factors of newly identified health conditions were determined. Odds ratios (OR) and their 95% confidence intervals were estimated using multivariate regression models with stepwise selection.
  
  
  RESULTS
  Prior to the HEROS clinic visit, 49% of patients had at least one previously known late complication of therapy. After the visit, a total of 98 new health conditions were identified in 73 patients (34%). Newly identified complications in screened patients included pulmonary dysfunction (23%), endocrinopathy (19%), osteoporosis (17%), dyslipidemia (8%), neurologic impairment (4%), cardiovascular deficit (3%) and subsequent cancer (3%). Age at cancer diagnosis (OR = 1.06 [1.00-1.11]), chest irradiation (OR = 2.92 [1.58-5.40]), and history of ≥1 other treatment-related complication(s) (OR = 2.20 [1.18-4.07]) were associated with a higher likelihood of having new conditions identified.
  
  
  CONCLUSIONS
  Risk-based screening at a specialty childhood cancer survivor clinic detected a substantial number of previously unrecognized, treatment-related health complications in a group of survivors already receiving regular medical care elsewhere.
authors.affiliation: Department of Pediatrics, Section of Hematology-Oncology, Yale School of Medicine, New Haven, Connecticut 06520, USA. maryjane.hogan@yale.edu
authors.forename: Mary-Jane
authors.initials: MJ
authors.lastname: Staba Hogan
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Ma
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods; D009369:Neoplasms / Q000150:complications*; D017741:Survivors; D055815:Young Adult