New health conditions identified at a regional childhood cancer survivor clinic visit†
Conflict of interest: The authors have indicated they have no conflict of interests or financial relationships relevant to this article to disclose. Dr. Kadan-Lottick was a St. Baldrick's Foundation Scholar and the HEROS clinic and database has also been funded in part by the American Cancer Society Scholar Grant 119700-RSGHP-10-107-01-CPHPS. These financial sources were not involved in the study design; collection, analysis, or interpretation of data; or in preparation or submission of the manuscript for publication.
Abstract
Background
Specialty childhood cancer survivorship clinics have been established to screen for potential treatment-related effects. Given the limited empirical data regarding the merit of survivorship clinics, we assessed the frequencies of newly identified, therapy-related effects in survivors who attended Health, Education, Research, Outcomes for Survivors (HEROS) clinic at Yale during 2003–2009.
Procedure
A total of 213 survivors in remission, who were diagnosed with cancer at an age ≤21 years and were ≥3 years after cancer diagnosis, underwent screening based on cancer treatment exposures according to the children's oncology group long-term follow-up guidelines. The frequencies and associated factors of newly identified health conditions were determined. Odds ratios (OR) and their 95% confidence intervals were estimated using multivariate regression models with stepwise selection.
Results
Prior to the HEROS clinic visit, 49% of patients had at least one previously known late complication of therapy. After the visit, a total of 98 new health conditions were identified in 73 patients (34%). Newly identified complications in screened patients included pulmonary dysfunction (23%), endocrinopathy (19%), osteoporosis (17%), dyslipidemia (8%), neurologic impairment (4%), cardiovascular deficit (3%) and subsequent cancer (3%). Age at cancer diagnosis (OR = 1.06 [1.00–1.11]), chest irradiation (OR = 2.92 [1.58–5.40]), and history of ≥1 other treatment-related complication(s) (OR = 2.20 [1.18–4.07]) were associated with a higher likelihood of having new conditions identified.
Conclusion
Risk-based screening at a specialty childhood cancer survivor clinic detected a substantial number of previously unrecognized, treatment-related health complications in a group of survivors already receiving regular medical care elsewhere. Pediatr Blood Cancer 2013; 60: 682–687. © 2012 Wiley Periodicals, Inc.
