Family doctors should be involved in long-term follow-up of childhood cancer survivors

18 Feb 2008

Family doctors should be involved in the long-term follow-up care of children who survive into adulthood after cancer, according to a Dutch study to be published in the March issue of The Lancet Oncology.

75% of children with cancer survive into adulthood due to improvements in treatment. These survivors are at particularly high risk of physical and psychosocial effects of treatment or possible recurrence of cancers, and long-term follow-up of these patients is important to identify any problems early on. But as children become adults, their care extends beyond the expertise of the paediatric oncologists who treated them, and as few as 17% of individuals who survive paediatric cancer will be receiving follow-up care at age 35 years, even though adverse effects can manifest many years later. "In our current study, most (85 of 121 [70%]) of the survivors who were recalled had not received information about the possibility of late effects from treatment before their visit, and consequently, were at risk of delayed medical care if health problems were to occur", explain the researchers from the University of Groningen in the Netherlands.

Ria Blaauwbroek and colleagues assessed the feasibility of involving family doctors in long-term follow-up care. 123 survivors of childhood cancer entered the study. Patients made two visits to a dedicated long-term follow-up clinic interspersed with a visit to a local family doctor where potential long-term late effects were assessed and discussed. Satisfaction of patients and doctors' with the family-doctor consultation was noted at the conclusion of the study. 89 (89%) of 101 patients who completed the study were satisfied with the shared care, as were 94 (82%) of the 115 family doctors. The authors conclude that shared care by dedicated long-term cancer follow-up clinics and family practitioners, which might increase the number of people under surveillance for adverse effects, is feasible.

"Paediatric oncologists are not the most appropriate health-care workers to care for survivors into late adulthood", the authors explain. Visits to dedicated cancer units might be difficult, time consuming, or stigmatising for patients, and provision of care by family doctors, in close collaboration with a long-term follow-up clinic, could increase the number of people who receive long-term follow-up after cancer treatment in childhood. Furthermore, as patients age, incorporating care related to cancer survival with more general care by family doctors will likely be more cost-effective than specialist care alone. "Loss of long-term cancer survivors to follow-up should be avoided because many of the potentially serious late effects might not manifest until decades after completion of treatment", the authors conclude