Risk-based care integrates the cancer experience with other things that should be considered when seeing a primary care provider.
—Melissa Hudson, MD
Melissa Hudson, MD, of St. Jude Children’s Research Hospital in Memphis, and lead author of a study finding that 98.2% of adult survivors of childhood cancer had a chronic health condition, told The ASCO Post that she hoped that survivors’ awareness of the need for ongoing health monitoring was increasing. She based that hope not only on news reports of study results underscoring the importance of ongoing monitoring, but on the establishment of long-term follow-up programs or late-effect clinics that provide information and health evaluations for survivors.
“Sometimes, it is just a matter of the patient personalizing the information, being ready to hear it and saying, ‘Yes, I understand this and now I need to seek the right type of follow-up,’” Dr. Hudson said. That presents an opportunity for physicians to elicit questions about possible late effects of treatment and encourage ongoing health monitoring.
Even for patients enrolled in long-term follow-up programs, it is important to “remember, we are seeing these patients when they are young, and we are talking to their parents,” Dr. Hudson said. “You may not have as many opportunities to speak to that survivor; you may be talking more to the parents.” Sometimes when patients came back for clinic visits, they would say that they didn’t realize the health problem they had could be related to cancer treatment they had received or even that they should be seeking long-term follow-up after treatment for childhood cancer, according to Dr. Hudson.
Patients may not be aware that cancer treatment can have delayed effects on lung, heart, and cognitive function. “It takes ongoing education at various times their after therapy course to set that foundation of this as a lifelong issue, that we need to continue to monitor them, even after we have changed therapy to what we think is safer,” Dr. Hudson said.
“We have to remind them that even if they’ve had low-risk therapy and everything seems fine now, as they age, they might see some of these conditions manifest, and we want to be sure that somebody is continuing to track their health as they are getting older,” she noted.
Importance of Oncologists in Transferring Information
Dr. Hudson stressed “the importance of oncologists helping to facilitate information transfer to the community providers who assume survivor care.” That information should include the details of the patient’s cancer history, the known health risks associated with the cancer and its treatment, and screening and surveillance recommendations or referrals to resources that are available to help guide screening and surveillance.
While there is no recommended standard or minimum set of health risk assessments that would apply to all adult survivors of childhood cancer, follow-up for late effects should at least include “a good health history and physical exam,” Dr. Hudson said. Detailed discussions about health history are particularly important for survivors with complicated cancer experiences. “This might require a separately scheduled visit where patients can discuss their cancer history and cancer treatment as part of their overall health history and share information provided by their oncologist with their primary care physician.” Dr. Hudson stated.
Research conducted through the Child Cancer Survivor studies, currently coordinated by St. Jude Children’s Research Hospital, and other cohort studies has shown that survivors are not currently receiving this type of follow-up care. “Risk-based care integrates the cancer experience with other things that should be considered when seeing a primary care provider—your family history, other comorbid conditions, and chronic health conditions that may have preceded or occurred after your cancer history,” Dr. Hudson said. “All those things need to be taken into account, as well as the former cancer history, because that is going to make a difference about what your health risks are as you begin to age.” ■