Adult Childhood Cancer Survivor Care Concerns General Internists

Research suggests that the majority of general internists lack adequate knowledge to provide optimal care for adult survivors of childhood cancer

medwireNews: Survey findings highlight the discomfort many general internists feel when caring for adult childhood cancer survivors (CCSs) and their lack of knowledge on surveillance recommendations.

The study, published in the Annals of Internal Medicine, includes responses from 1110 (61.6%) US general internists who were asked to complete a postal questionnaire between 2011 and 2012.

Overall, 51.1% of physicians said they cared for at least one adult who had survived childhood acute lymphoblastic leukaemia, Hodgkin lymphoma or osteosarcoma, and the majority (84.0%) said they preferred to do so in tandem with a specialist cancer centre or long-term follow-up clinic.

Despite being willing to treat such patients, many of the general internists said they were “somewhat uncomfortable” caring for CCSs, report Tara Henderson (University of Chicago, Illinois, USA) and co-authors.

Just 36.9% of physicians stated they were “somewhat comfortable” or “comfortable” caring for survivors of Hodgkin lymphoma, as did 27.0% of those caring for survivors of acute lymphoblastic leukaemia and 25.0% of those looking after survivors of osteosarcoma.

Furthermore, only 12.0% of general internists said they were at least “somewhat familiar” with guidelines for surveillance of CCSs.

When physicians were assessed using a clinical vignette, 76.4% of general internists advised CCSs to undergo annual thyroid dysfunction testing as part of the North American Children’s Oncology Group (COG) surveillance guidelines.

However, just 9.4% recommended annual breast cancer imaging for women who received chest radiation, and only 14.9% correctly advised biennial echocardiography to check for cardiac dysfunction. Indeed, only 5.4% of physicians correctly answered all three COG surveillance questions.

Of note, general internists who had seen one or more CCSs in the past 5 years were significantly more likely to suggest annual breast cancer surveillance using mammography or mammography plus magnetic resonance imaging than those who had not.

“[F]indings from this study will provide a platform for intervention research targeting education of [primary care physicians] and dissemination of [survivorship care plans] in the hope of ultimately improving physician knowledge and comfort in caring for this high-risk population,” the authors say.

In an accompanying editorial, Dava Szalda and Jill Ginsberg, from the Children’s Hospital of Philadelphia in Pennsylvania, USA, note that approximately one in 700 young adults in the USA is a CCS and therefore at risk of chronic health conditions, such as end-organ damage and secondary cancer.

“Successful care of CCSs is a shared responsibility among pediatric oncology care providers, patients acting as their own advocates, and internists who will become the source of ongoing care for this growing patient population,” they believe.

“Integration of innovative educational approaches for internists in the established medical school curriculum and beyond and the implementation of thoughtful, patient-focused transition practices will help to eliminate current disparities in the care of CCSs.”

References

Suh E, Daugherty C, Wroblewski K, et al. General Internists’ Preferences and Knowledge About the Care of Adult Survivors of Childhood Cancer. Ann Intern Med 2014; 160: 11–17. doi:10.7326/M13-1941.

Szalda D, Ginsberg J. The Adult Childhood Cancer Survivor and the General Internist: Suggestions for Patient and Provider Education. Ann Intern Med 2014; 160: 66–67. doi:10.7326/M13-2718

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