Survivors of childhood cancer and use of health care services

As part of a retrospective study on long-term survivors of childhood cancer in Canada, information on use of health care services was obtained.
Survivors were eligible for study if they had been diagnosed or treated for a first, primary malignancy before 20 years of age, between 1981 and 1990, and had survived at least 5 years after diagnosis. Their responses were compared to a random sample of age and sex match population controls.
Information was gathered from 2152 survivors and 2432 controls.
Similar proportions of survivors and controls (71% and 73%, respectively) consulted a general practitioner in the past year, while significantly more survivors than controls reported seeing a specialist (68% versus 46%).
Regarding specialists, survivors were much more likely than controls to consult with an oncologist (29% verus 0.3%) or haematologist (14% versus 0.6%). Assuming consulting an oncologist indicates receiving cancer-related follow-up care, the large majority of survivors may not be receiving optimal care of at least one follow-up visit per year with a practitioner familiar with long-term care of childhood cancer survivors.
Among survivors, consultations with an oncologist varied by socio-demographic and clinical factors. Survivors with higher education were more likely to visit an oncologist, likely indicating a greater understanding of the long-term effects associated with childhood cancer therapy. Visits to an oncologist were also elevated among survivors with two or more physical health problems, those exposed to high risk therapy, and those whose therapy was extended due to a recurrence or incomplete response. However, consultations with an oncologist decreased with older age at study and longer time since diagnosis, exactly when the risk of late effects increases. By age 25, or 15 years past diagnosis, fewer than 15% of survivors reported consulting an oncologist in the past year. This limited preventive care could have implications on survivors’ long-term health.

Bibliographical reference:

Shaw AK et al.: "Use of health care services by survivors of childhood and adolescent cancer in Canada", Cancer. 2006 Apr 15;106(8):1829-37

Amanda Shaw

Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada