Few young cancer survivors get best follow-up

Many survivors of childhood cancer are not getting the optimal follow-up care recommended for detecting the long-term consequences of cancer treatment, according to a study of Canadian patients.

Though the majority of children and teenagers with cancer can be cured, they still face a risk of long-term, or "late," effects from the drugs and radiation used to fight the cancer.

These effects vary widely and depend on a number of factors, such as the type of cancer and the type and duration of treatment. But they can include anything from problems with memory, attention or intellectual ability to damage to the heart, lungs or other organs. Treatments for certain cancers may harm hearing or vision, while some can affect future fertility.

Childhood cancer survivors are also at greater-than-average risk of developing a second cancer later in life.

Because of all these potential health threats, experts advise patients to regularly see a specialist trained in the long-term care of childhood cancer survivors.

Of the more than 2,000 survivors in the new study, the majority said they'd seen a general practitioner in the past year, but only 29 percent had been to a cancer specialist.

This suggests that the "large majority of survivors may not be receiving optimal care," the study authors, led by Amanda K. Shaw of the Public Health Agency of Canada, report in the journal Cancer.

The reasons for the lapse are not clear. But, the researchers note, the findings are "strikingly similar" to what's been seen in the U.S., despite Canada's universal healthcare coverage.

The study included 2,152 childhood cancer survivors who ranged in age from 6 to 37, and a comparison group of healthy individuals matched to patients by age and sex. The groups were similar in the percentage who'd seen a general practitioner in the past year, at about 70 percent.

Among cancer survivors, less than one-third said they'd seen an oncologist during the previous year, with the likelihood diminishing as patients grew older - at exactly the time, Shaw and her colleagues write, that the risk of health problems and death go up.

Other studies, the researchers note, have found that cancer survivors are often unaware of the details of their treatment and the potential long-term health risks.

Coupled with past research, they conclude, the new findings "raise concern regarding the appropriate education and follow-up care of childhood cancer survivors and should be addressed by both the pediatric and adult oncology community."

SOURCE: Cancer, April 2006.