Medical care in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Medical care in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
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DOI：
10.1200/jco.2008.16.9607
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发表时间：
2008-09-20
影响因子：
45.3
通讯作者：
Oeffinger, Kevin C.
中科院分区：
文献类型：
--
作者：
Nathan, Paul C.;Greenberg, Mark L.;Oeffinger, Kevin C.
目的评估儿童癌症幸存者是否接受了针对其治疗引起的特定发病率的常规医疗护理。患者和方法我们对儿童癌症幸存者研究中的8,522名参与者进行了横断面调查，该研究是一个多机构的儿童癌症幸存者队列。我们评估了前两年的就诊情况，这些就诊是否与既往癌症有关，幸存者是否接受了如何降低长期风险的建议，以及是否讨论或安排了筛查测试。对心肌病或乳腺癌高危患者的超声心动图和乳房X光检查的完成性进行评估。结果癌症确诊时的中位年龄6.8岁(0~20.9岁)，就诊时的中位年龄31.4岁(17.5~54.1岁)。尽管88.8%的幸存者报告接受了某种形式的医疗护理，但只有31.5%的幸存者报告了专注于他们先前癌症的护理(以幸存者为重点的护理)，17.8%的幸存者报告以幸存者为重点的护理，包括关于降低风险或讨论或安排筛查测试的建议。在接受医疗护理的幸存者中，那些黑人、面谈时年龄较大或没有保险的人接受基于风险的、以幸存者为重点的护理的可能性较小。在心肌病或乳腺癌风险增加的患者中，1810名患者中有511名(28.2%)接受了推荐的超声心动图或乳房X光检查，414名患者中有169名(40.8%)接受过推荐的超声心动图或乳房X光检查。结论尽管癌症治疗后有明显的晚期效应风险，但大多数儿童癌症幸存者没有接受推荐的基于风险的护理。
PurposeTo evaluate whether childhood cancer survivors receive regular medical care focused on the specific morbidities that can arise from their therapy.Patients and MethodsWe conducted a cross-sectional survey of health care use in 8,522 participants in the Childhood Cancer Survivor Study, a multi-institutional cohort of childhood cancer survivors. We assessed medical visits in the preceding 2 years, whether these visits were related to the prior cancer, whether survivors received advice about how to reduce their long-term risks, and whether screening tests were discussed or ordered. Completion of echocardiograms and mammograms were assessed in patients at high risk for cardiomyopathy or breast cancer. We examined the relationship between demographics, treatment, health status, chronic medical conditions, and health care use.ResultsMedian age at cancer diagnosis was 6.8 years (range, 0 to 20.9 years) and at interview was 31.4 years (range, 17.5 to 54.1 years). Although 88.8% of survivors reported receiving some form of medical care, only 31.5% reported care that focused on their prior cancer (survivor-focused care), and 17.8% reported survivor-focused care that included advice about risk reduction or discussion or ordering of screening tests. Among survivors who received medical care, those who were black, older at interview, or uninsured were less likely to have received risk-based, survivor-focused care. Among patients at increased risk for cardiomyopathy or breast cancer, 511 (28.2%) of 1,810 and 169 (40.8%) of 414 had undergone a recommended echocardiogram or mammogram, respectively.ConclusionDespite a significant risk of late effects after cancer therapy, the majority of childhood cancer survivors do not receive recommended risk-based care.