Most general internists are willing to care for adult survivors of childhood cancer, but many are uncomfortable doing so, according to the results of a nationally representative survey.
In fact, on average, the 1,110 survey respondents reported being "somewhat uncomfortable" caring for survivors, and being "somewhat unfamiliar" with available surveillance guidelines for long-term follow-up care of survivors, reported Dr. Eugene Suh of Loyola University Medical Center, Maywood, Ill., and his colleagues.
Only 37%, 27%, and 25% of respondents reported being "somewhat comfortable or "comfortable" caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma, respectively. After adjustment for a number of factors, higher levels of comfort in treating childhood cancer survivors were seen in physicians with larger patient volumes, those who had cared for at least 1 survivor during the preceding 5 years, and men.
Furthermore, only 12% of respondents reported being generally familiar with available surveillance guidelines for childhood cancer survivors, and this was borne out in responses to a clinical vignette about a young female survivor of Hodgkin lymphoma. Only 9%, 15%, and 76% of respondents recommend breast cancer surveillance, cardiac surveillance, and thyroid surveillance, respectively, in accordance with guidelines, and only 5% answered all three surveillance questions in accordance with guidelines, the investigators reported. The study was published in the Jan. 7 issue of Annals of Internal Medicine.
The findings are concerning given that more than 80% of adult childhood cancer survivors – a "growing and clinically challenging population" – receive health care from a primary care physician in their community, the researchers noted (Ann. Intern. Med. 2014;160:11-7 [doi:10.7326/M13-1941]).
Chemotherapy and radiation used to treat childhood cancer survivors are associated with significant risk for second malignant neoplasms and a number of other health concerns, including damage to vital organs, which can result in chronic illness and premature death, they added.
The survey was conducted between September 2011 and August 2012 in a random sample of 2,000 U.S. general internists; 62% responded. Questions regarding care preferences and comfort level with caring for adult childhood cancer survivors were answered using a 7-point Likert scale (with responses ranging from very uncomfortable to very comfortable, for example), and adherence to Children’s Oncology Group Long-Term Follow-Up Guidelines was assessed based on responses to clinical vignette. For the purposes of this study, a childhood cancer survivor was defined as a patient diagnosed with cancer at or before age 21 years, at least 5 years from cancer therapy completion, and cancer free.
More than half of the respondents (52%) reported caring for at least one survivor. Only 61 (5.5%) said they preferred to care for childhood cancer survivors independently, while 84% preferred to work in collaboration with a cancer center–based physician or long-term follow-up clinic, and 11% said they would refer survivors to a cancer center–based physician or clinic or to another primary care physician.
Although access to treatment summaries and surveillance guidelines were listed as particularly useful resources, 72% of those respondents said they never received a patient treatment summary.
The findings highlight a critical gap in some physicians’ knowledge of available guidelines as well as the need for improved attention to survivorship care plans (SCPs), which are a cornerstone of recommendations for long-term follow-up care of childhood cancer survivors, the investigators said.
These plans created by the oncology team provide survivors and physicians with a road map for care. Such plans include a cancer treatment summary as well as information about potential late treatment effects, guidelines for surveillance, and contact information for the oncology team.
"Concentrated efforts to improve these gaps should include enhanced education of [primary care physicians] through webinars, education sessions at national meetings, and guidelines linked to internal medicine websites. Focused efforts should also be made to improve comanagement by oncologists and [primary care physicians] throughout the cancer care trajectory," they concluded, noting that electronic medical records, web-based tools, and smartphone/tablet apps could allow for streamlining of SCP creation and dissemination.
The study was funded by the National Cancer Institute. The authors reported no relevant conflicts of interest.