Children's Cancer and Environmental Exposures: Professional Attitudes and Practices.
BACKGROUND
Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists.


METHODS
A web-based survey was sent from June to October 2012 to 427 pediatric oncologists, fellows, and nurse practitioners from 20 US institutions, with an overall response rate of 45%.


RESULTS
Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis. Although 77% of respondents suspected that some of the cases they saw had an environmental origin, their methods of taking environmental histories varied widely. Over 90% of respondents believed that more knowledge of the associations between environmental exposures and childhood cancer would be helpful in addressing these issues with patients.


CONCLUSIONS
Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.
*Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco †Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley ‡Stanford University School of Medicine, Stanford, CA §Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT ∥Dana-Farber Cancer Institute, Boston, MA.
Christine M
CM
Zachek
Mark D
MD
Miller
Christopher
C
Hsu
Joshua D
JD
Schiffman
Stephen
S
Sallan
Catherine
C
Metayer
Gary V
GV
Dahl
D002648:Child; D004781:Environmental Exposure / Q000009:adverse effects*; D005257:Fellowships and Scholarships; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000209:etiology*; D009722:Nurse Practitioners; D010372:Pediatrics; D010820:Physicians; D011795:Surveys and Questionnaires