ASCO: Childhood Cancer Survivors Getting Inadequate Care as Adults

CHICAGO, June 3 -- Less than a third of the survivors of childhood cancer get routine cancer-related health care as young adults, even though they are likely to have more serious need than others their age, researchers found.

"About 12% of these patients receive no health care at all," Paul Nathan, M.D., of the University of Toronto, told attendees at the American Society of Clinical Oncology meeting here.

Dr. Nathan and colleagues in the United States and Canada surveyed more than 17,000 patients who had been treated for cancer as children during the 16-year period from 1970 to 1986. They received responses from 8,522 to questions designed to determine the type of health care the patients were currently receiving.

"These are a motivated group of patients, so it is probable that what we are reporting is actually a 'best case scenario'," Dr. Nathan explained.

Among the researchers' findings:

• 56% of the patients received general health care in which doctors performed routine tests and examinations without inquiring about the patients' cancer histories
• 32% of the patients were given cancer-related health care
• Only 18% received risk-based care that considered the types of complications likely to occur to survivors of childhood cancer

For example, Dr. Nathan said, those risk-based tests could include screening for breast cancer at earlier ages for women who had undergone radiation treatments as children.

About 20% of women who received chest radiation for cancer during childhood will develop breast cancer before age 45, Dr. Nathan said, yet only 49% of the women in the sample said they received mammograms.

He also said that as many as 50% of patients who survive childhood cancer and had been treated with anthracycline are at risk for heart disease, yet just 28% of the surveyed patients had received echocardiograms.

Of the 12% of patients who received no current health care, Dr. Nathan said those at greatest risk were poor, uninsured, and more likely to be men.

Those most likely to be given risk-related care, he said, were sicker survivors.

"We must realize that this group represents the tip of the iceberg," commented Archie Bleyer, M.D., DEFEAT Cancer Director at St. Charles Medical Center in Bend, Ore. "I believe that the rest of these at-risk patients are likely receiving even less care and are at no less risk," he added.

Dr. Bleyer said the problem lies both with the patients-some of whom may be reluctant to divulge their cancer history-and with their doctors who fail to probe deeply enough when taking a medical history.