General Internists’ Preferences and Knowledge About the Care of Adult Survivors of Childhood Cancer

Abstract

Background Adult childhood cancer survivors (CCSs) are at high risk for illness and premature death. Little is known about the physicians who provide their routine medical care. Objective To determine general internists’ self-reported attitudes and knowledge about the care of CCSs. Design Cross-sectional survey. Setting Mailed survey delivered between September 2011 and August 2012. Participants Random sample of 2000 U.S. general internists. Measurements Care preferences, comfort levels with caring for CCSs (7-point Likert scale: 1 = very uncomfortable, 7 = very comfortable), familiarity with available surveillance guidelines (7-point Likert scale: 1 = very unfamiliar, 7 = very familiar), and concordance with Children’s Oncology Group Long-Term Follow-Up Guidelines in response to a clinical vignette. Results The response rate was 61.6% (1110 of 1801). More than half the internists (51.1%) reported caring for at least 1 CCS; 72.0% of these internists never received a treatment summary. On average, internists were “somewhat uncomfortable” caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma. Internists reported being “somewhat unfamiliar” with available surveillance guidelines. In response to a clinical vignette about a young adult survivor of Hodgkin lymphoma, 90.6% of respondents did not appropriately recommend yearly breast cancer surveillance, 85.1% did not appropriately recommended cardiac surveillance, and 23.6% did not appropriately recommend yearly thyroid surveillance. Access to surveillance guidelines and treatment summaries were identified as the most useful resources for caring for CCSs. Limitation Findings, based on self-report, may not reflect actual clinical practice. Conclusion Although most general internists report involvement in the care of CCSs, many seem unfamiliar with available surveillance guidelines and would prefer to follow patients in collaboration with a cancer center. Primary Funding Source National Cancer Institute.

Self-reported endocrine late effects in adults treated for brain tumours, Hodgkin and non-Hodgkin lymphoma: a registry based study in Northern Germany

“…This may have a major impact on the care of patients as the specific needs of long-term cancer survivors concerning these endocrine problems may not be sufficiently met in the transition from primary oncological care to routine GP follow-up (15,50,51). Moreover, complex endocrinological disorders such as pituitary deficiency require specialized endocrinological evaluation not generally included in the previous mentioned settings which may result in these diseases remaining underdiagnosed despite annual medical contact in the vast majority of patients.…”

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

“…Many feel unprepared to take on postcancer care independently. [40][41][42] In a hybrid model, PCPs share care with a cancer center team that provides guidance on cancer-related issues. No studies compare effectiveness of these models.…”

Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

“…Recent surveys of general internists suggest that many remain uncomfortable providing risk-based survivor-focused medical care to long-term adult survivors of childhood cancer. 28,29 Outreach and education for these providers are particularly important given the well-described association between receiving a physician recommendation for riskbased screening and completion of recommended mammogram, [30][31][32] echocardiogram, and bone density screening. 30,33 In the general population, cancer screening rates vary according to population-level factors, with lower breast cancer screening rates in communities with lower mammogram capacity, 15 and lower breast and colon cancer screening rates in communities with higher area-level poverty rates.…”