Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 25, No 18S (June 20 Supplement), 2007: 6502
© 2007 American Society of Clinical Oncology


Risk-based care in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS)

P. C. Nathan, M. L. Greenberg, K. K. Ness, M. C. Mahoney, J. G. Gurney, M. M. Hudson, S. S. Donaldson, W. M. Leisenring, L. L. Robison and K. C. Oeffinger

The Hospital for Sick Children, Toronto, ON, Canada; St. Jude Children's Research Hospital, Memphis, TN; Roswell Park Cancer Institute, Buffalo, NY; University of Michigan, Ann Arbor, MI; Stanford Medical Center, Stanford, CA; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY


Background: Childhood cancer survivors are at significant risk of morbidity as a result of their therapy. Thus, they require regular medical follow-up focused on their specific long-term risks. We examined the frequency and type of care received by a cohort of adult survivors of childhood cancer and examined the predictors of the receipt of appropriate risk-based care. Methods: Eligible subjects were members of the CCSS, a multi-institutional study of patients who have survived at least 5 years after being diagnosed with childhood cancer between 1970 and 1986. Participants completed a baseline survey and a subsequent survey on health care contact within the preceding 2 years. Contact was classified hierarchically as general care, cancer-related care, basic risk-based care and optimal risk-based care. Optimal risk-based care was assessed only in patients whose therapy is associated with a substantial risk of cardiac disease (=300 mg/m2 of an anthracycline, or any anthracycline plus chest radiation) or breast cancer (females who received chest radiation who are =27 years). Univariate and multivariable analyses were performed to assess associations between demographic/treatment variables and health care outcomes using logistic regression models. Results: The health care questionnaire was completed by 8,448 survivors. Median age (range) at diagnosis was 6.8 (0–21.0) years and at assessment was 31.4 (17.5–54.1) years. 87% reported general medical contact, 31% cancer- related care and 12% basic risk-based cancer care. Amongst patients at increased risk of cardiac disease (N=1,798) or breast cancer (N=852), only 28% reported receiving an echocardiogram and 49% a mammogram, respectively. Patients without health insurance (odds ratio [OR]=2.22, 95% confidence interval [CI]=1.56–3.13, p<0.0001 by Wald statistic), males (OR=1.19, 95% CI=1.03–1.37, p=0.02), younger patients (OR=1.03, 95% CI=1.02–1.04, p<0.0001) and those who perceived their health as good/excellent (OR=1.37, 95% CI=1.13–1.65, p=0.001) were at increased risk of not having received basic risk-based care. Conclusions: Despite a significant risk of late effects after cancer therapy, the majority of adult survivors of childhood cancer do not receive appropriate risk-based health care.

No significant financial relationships to disclose.

Abstract presentation from the 2007 ASCO Annual Meeting