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While the majority of survivors of childhood cancer receive regular medical care, few receive care focused on the specific risks resulting from their prior cancer therapy, according to findings.

While the majority of survivors of childhood cancer receive regular medical care, few receive care focused on the specific risks resulting from their prior cancer therapy, according to findings published in the September 20th issue of the Journal of Clinical Oncology.

"With contemporary therapy, 80 per cent of children diagnosed with cancer will become long-term survivors," Dr. Paul C. Nathan from the Hospital for Sick Children, Toronto, and colleagues write. "Consequently, more than 270,000 survivors of childhood cancer are alive in the United States, many of whom are at risk of long-term morbidity and premature mortality as a result of their therapy."

The researchers conducted a cross-sectional survey of health care use with 8522 participants of the Childhood Cancer Survivor Study. The subjects were asked if they had a medical visit in the preceding two years. The authors subsequently assessed whether these visits were related to the prior cancer, whether the survivors received advice on how to reduce their risks, and whether screening tests were discussed or ordered.

Completion of echocardiograms and mammograms were confirmed in a subset of participants at high risk for cardiomyopathy or breast cancer. The association between demographics, treatment, health status, chronic medical conditions, and heath care use was evaluated.

During the two-year study period, 953 survivors (11.2 per cent) reported receiving no medical care. Overall, 4882 survivors (57.3 per cent) received general medical care, 1166 (13.7 per cent) received general survivor-focused care, and 1521 (17.8 per cent) received recommended risk-based care. Care at a cancer center was reported by only 1246 patients (14.6 per cent).

Survivors who were older, male, black, or uninsured were more likely to receive general medical care only. Subjects who had moderate or extreme cancer-related pain or anxiety, poor physical health, or more serious morbidity were more likely to receive risk-based, survivor-focused care.

Of 1810 survivors at risk of cardiomyopathy for whom an echocardiogram was indicated, only 511 (28.2 per cent) reported having the procedure. A mammogram was indicated in 414 women based on their high risk of developing breast cancer. Of these, only 169 (40.8 per cent) women reported receiving a mammogram.

Subjects who received care in a cancer center were more likely than those who received care elsewhere to have undergone an indicated echocardiogram (53.2 per cent versus 22.3 per cent) or mammogram (62.4 per cent versus 34.6 per cent).

"We need to find and test strategies aimed at educating survivors and their primary care physicians about the long-term risks of their cancer therapy, and about the medical care and surveillance testing that is recommended in order to prevent, detect or treat these problems before they have a significant impact on patients' health and quality of life," Dr. Nathan said in an interview with Reuters Health.

"A major component of this must involve the empowerment of survivors," he noted. "Many survivors are not aware of the kinds of therapy that they received as children and therefore are poorly informed about their long-term risks and the health care strategies needed to reduce those risks," he explained. "We need to give them tools (such as treatment summaries and comprehensive care plans) so that they can advocate with their primary care physicians to ensure that they are receiving optimal care."

J Clin Oncol 2008;26:4401-4409