title: Non-oncology physician visits after diagnosis of cancer in children.
abstract: Children diagnosed with cancer often require extensive care for medical, psychosocial and educational problems during and after therapy. Part of this care is provided by family physicians and non-cancer specialists, but their involvement in the first years after diagnosis has barely been studied. Studying non-oncology physician visits may provide insight into the roles of different health care providers.
  
  
  
  We included 757 children diagnosed with cancer under age 15 between 1991 and 2001 from a Canadian provincial registry, and matched each to 10 controls of the same birth year and sex. We determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis (for patients) or inclusion (for controls) using data from the provincial health insurance plan.
  
  
  
  In the first year after diagnosis, almost all patients visited both a family physician and non-cancer specialist. Although after 5 years percentages decreased to 85 and 76 %, respectively, these were still significantly higher than in controls. In the first year after diagnosis, both family physicians and non-cancer specialists were often consulted for neoplasms (62 and 90 %, respectively) and to discuss results of lab tests. In addition, family physicians were often consulted for general symptoms and non-cancer specialists for nervous system problems and complications of medical care.
  
  
  
  Family physicians and non-cancer specialists are highly involved in the care for children with cancer in the first years after diagnosis, including for health problems related to cancer or its treatment. This necessitates good communication among all physicians.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands. m.heins@nivel.nl.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Heins
authors.affiliation: BC Cancer Research Centre, BC Cancer Agency, Vancouver, Canada.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Lorenzi
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O Box 1568, 3500 BN, Utrecht, The Netherlands.
authors.forename: Joke C
authors.initials: JC
authors.lastname: Korevaar
authors.affiliation: BC Cancer Research Centre, BC Cancer Agency, Vancouver, Canada.
authors.forename: Mary L
authors.initials: ML
authors.lastname: McBride
mesh_terms: D000293:Adolescent; D001955:British Columbia; D002309:Cardiology / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy; D009422:Nervous System Diseases / Q000628:therapy; D009819:Office Visits / Q000706:statistics & numerical data* / Q000639:trends; D010372:Pediatrics / Q000706:statistics & numerical data; D010819:Physician's Role; D012141:Respiratory Tract Infections / Q000628:therapy; D063189:Symptom Assessment; D013997:Time Factors
keywords: Child; Child health services; Leukemia; Lymphoma; Neoplasms; Primary health care