Medical Care in Long-Term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

TLDR

The study aimed to determine whether childhood cancer survivors receive regular, therapy‑specific medical care. Researchers surveyed 8,522 survivors, reviewing the past two years of health‑care visits, counseling on risk reduction, and screening orders, and examined how demographics, treatment, and health status related to care utilization. Although 88.8% of survivors had some medical care, only 31.5% received survivor‑focused care and 17.8% received risk‑based counseling or screening, with black, older, and uninsured patients less likely to receive such care, and only 28.2% of high‑risk patients had recommended echocardiograms and 40.8% had mammograms, indicating most survivors miss recommended risk‑based care.

Abstract

Purpose To evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy. Patients and 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. Conclusion Despite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.