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Many Childhood Cancer Survivors Not Checking for Second Malignancies
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And some survivors suffer from post-traumatic stress disorder years after beating their disease, two new studies show.
Not following screening guidelines can be costly because childhood cancer survivors are more likely to develop a new cancer, and to die of that new cancer, than the regular population, the researchers noted. The findings were presented during a Monday press conference at the American Society of Clinical Oncology annual meeting, in Orlando, Fla.
"This information on screening is very relevant for two reasons. First, one-third of all survivors develop life-threatening illnesses and two-thirds develop other kinds of complications, said Dr. Smita Bhatia, head of the childhood survivorship clinic at City of Hope Cancer Center in Duarte, Calif. "Both the cancer survivors and health-care providers are not aware of this. There is a need for ongoing regular, long-term, lifelong screening of these patients, to find complications early and act upon them."
For the study, some 8,000 questionnaires completed by childhood cancer survivors found that only 11.5 percent of those who were at high risk for a new cancer got colonoscopies; only 46 percent got mammograms; and only 27 percent got skin exams.
"Care at a cancer center predicted increased surveillance for breast and skin cancer, but the majority of survivors get care from a family practitioner," said study author Dr. Paul Nathan, a staff oncologist with the Hospital for Sick Children in Toronto. "Survivors and physicians need to be educated about regular screening and survivors need to know what treatments they received because, at the end of the day, they are the best advocates for their own screening."
Added Dr. Aziza Shad, director of the cancer survivorship program at Georgetown University's Lombardi Cancer Center: "The problem is that many primary care providers are not up to date on the guidelines. We haven't been able to provide education for primary care providers, and there are so many other doctors who also provide care."
The second study, also using data from the Childhood Cancer Survivors Study, found that 9 percent of childhood cancer survivors showed signs or symptoms of post-traumatic stress disorder (PTSD) long after their diagnosis and treatment, compared with 2 percent of their healthy siblings.
"This is very, very significant, a more than four-fold increase in risk," said study author Dr. Margaret Stuber, the Jane and Marc Nathanson professor of psychiatry at the University of California, Los Angeles David Geffen School of Medicine.
Intense treatment, as well as radiation to the brain, before the age of 4 were predictors of later PTSD, the study found.
Having PTSD was also associated with other worrisome issues. "People with PTSD were less likely to be employed, less likely to have finished high school, have personal incomes under $20,000 per year, and less likely to be married than the rest of the survivor group," Stuber said.
"The good news is that 90 percent of cancer survivors are resilient," Stuber said.
In other research presented at the Monday press conference, Greek researchers reported that radiating only the part of the breast affected by cancer is just as effective as radiating the entire breast in terms of overall survival and metastasis.
However, the meta-analysis of three previous trials also found that local recurrences were more common in women undergoing partial irradiation.
The advantage of the partial-breast regimen is that it lasts only five days, as opposed to five weeks for conventional radiation and therefore can improve compliance, said Dr. Jennifer C. Obel, an attending physician at NorthShore University Health System in Illinois and moderator of the press conference.
"But before we say this should be the standard of care, we should await the findings of many randomized trials forthcoming in the next years," she added.
In other news at the meeting, researchers from the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., reported that while upwards of 70 percent of oncologists surveyed discuss fertility and preservation methods with their patients of childbearing age, less than 50 percent of patients are receiving adequate information on the topic.
And researchers from Thomas Jefferson University in Philadelphia found that colon cancer patients who receive treatment for often severe drug-related skin rashes before the rashes appear are less likely to have the side effect.
SOURCES: Smita Bhatia, head, childhood survivorship clinic, City of Hope Cancer Center, Duarte, Calif.; Aziza Shad, M.D., director of the cancer survivorship program, Georgetown University's Lombardi Cancer Center, Washington, D.C.; June 1, 2009, press conference with Jennifer C. Obel, M.D. attending physician, NorthShore University Health System, Illinois; Paul Nathan, M.D., staff oncologist, Hospital for Sick Children, Toronto; Margaret Stuber, M.D., the Jane and Marc Nathanson professor of psychiatry, University of California, Los Angeles, David Geffen School of Medicine; June 1, 2009, American Society of Clinical Oncology annual meeting, Orlando, Fla.
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