Longitudinal risk-based health care for adult survivors of childhood cancer

✍ Scribed by Kevin C. Oeffinger

• Publisher: Elsevier Science
• Year: 2003
• Tongue: English
• Weight: 159 KB
• Volume: 27
• Category: Article
• ISSN: 0147-0272
• DOI: 10.1016/s0147-0272(03)00031-x

✦ Synopsis

ong-term survivors of childhood cancer represent a growing, at-risk, and vulnerable population with health care needs that are not being met through our current medical system. Childhood cancer survivors, though being "cured," often experience late effects, both physical and psychological, secondary to their cancer treatment. As many as two thirds of survivors of childhood cancer will experience a late effect secondary to their previous cancer treatment. [1][2][3][4] Commonly, survivors have more than one late effect, with perhaps as many as a quarter of them experiencing one that is severe or life-threatening. 1,3,4 All organ systems are at risk, with late effects including cognitive impairment, infertility, alterations in growth and development, organ system damage, second malignant neoplasms, and quality of life issues. [1][2][3][4][5][6][7] Importantly, many late effects may not occur or become clinically symptomatic until many years after completion of therapy.

Based on the potential for late effects of cancer therapy, the National Cancer Policy Board strongly encourages life-long follow-up of all cancer survivors. 8 Despite this recommendation, most adult survivors of childhood cancer do not seek or receive periodic health care that addresses their risk based on previous therapy and modifying factors. This article discusses the rationale for longitudinal health care for this vulnerable population, describes the current status of such health care in the U.S., and provides a theoretical framework to determine barriers and enablers that must be addressed to ameliorate the inadequacies of the current health care system.

Rationale for Longitudinal Risk-Based Health Care

The rationale for long-term follow-up of survivors of childhood cancer is based on two assumptions: 1) screening and surveillance for late effects can lead to early diagnosis and intervention that will improve outcomes and quality of life; and 2) how and to what extent radiation and