ORLANDO – Pediatricians need to be positioned to offer survivor care to the more than 80% of pediatric cancer patients who now survive their disease, according to Dr. Melissa Hudson.
"We have in excess of 479,000 individuals living in the United States diagnosed with cancer before the age of 21 ... and we know with those numbers increasing, you will be increasingly seeing them in your practices," Dr. Hudson, director of the cancer survivorship division, department of oncology at St. Jude Children’s Research Hospital, Memphis, Tenn., said at the annual meeting of the American Academy of Pediatrics.
Dr. Melissa Hudson
Health-related issues that affect these cancer survivors include the risk for recurrence, potential late effects of treatment, and psychosocial effects related to the cancer experience, Importantly, health care needs in these patients change over time and across the spectrum of care. Ideally, pediatricians will provide these patients with risk-based survivor care that includes health education, anticipatory guidance based on cancer history and specific cancer-related health risks, and cancer and other health screening and surveillance as recommended based on the patient’s specific treatment exposures, she said.
In particular, patients need to be educated about the impact of their health behaviors on cancer-related health risk and about effective self-management of chronic health conditions.
The common chronic conditions that follow cancer often can impact growth and development – including linear growth, skeletal maturation, intellectual functioning, emotional and social maturation, and sexual development.
Recently published data from the St. Jude Lifetime Cohort Study showed that 95.5% of nearly 1,700 adult survivors of pediatric cancer had at least 1 chronic health condition by age 45 years, and nearly 81% had a serious disabling or life-threatening condition (J. Clin. Oncol. 2013;31:4242-51). Data from the retrospective Childhood Cancer Survivor Study similarly showed that, compared with population controls, survivors have a higher rate of premature mortality, largely from subsequent malignancies, which confer a 15-fold excess risk of death; cardiac conditions, which confer a sevenfold excess risk of death; and pulmonary conditions, which confer a nearly ninefold excess risk of death.
Survivor care also needs to consider that treatment-related issues, ongoing cancer risk, and the cancer experience in general can combine to have important psychosocial effects
Mental health factors can include body image issues, adverse effects of the cancer experience on educational and vocational goals, and late cognitive effects. Survivors also face insurance discrimination and access to care issues due to financial issues associated with medical bills and under- or unemployment.
Many survivors also struggle with ongoing symptoms such as fatigue, disrupted sleep, memory problems, concentration issues, and chronic pain; some have difficulty living independently because of the severity of these symptoms, and the effects can have a negative impact on social interactions with family and friends.
"We need to help them achieve access to resources to optimize their quality of life," Dr. Hudson said.
When cancer survivors return to primary care, they should present with a treatment summary. If they don’t, one should be requested from the cancer treatment center to help guide care, she said.
Become familiar with practice guidelines for caring for survivors of childhood cancers, and be prepared to work with either the oncology care center to help facilitate the transition to pediatric care, she said.
The Children’s Oncology Group (COG), a consortium of medical research institutions, provides numerous tools for care providers and patients. Dr. Hudson, who co-chaired the task force that established the care guidelines, said that they provide recommendations for screening and management of late effects that can arise in pediatric cancer survivors. These patient education handouts can be printed free of charge and many are available in Spanish and French as well as in English. An updated version (4.0) of the COG guidelines is pending release by early 2014, Dr. Hudson said.
Dr. Hudson reported having no disclosures.