Survey Finds Many General Internists Are Uncomfortable Caring for Adult Survivors of Childhood Cancer
A National Cancer Institute–funded survey of general internists asking about their attitudes and knowledge about the care of adult childhood cancer survivors has found that few internists are comfortable caring for these patients. Moreover, many are unfamiliar with the Children’s Oncology Group (COG) surveillance guidelines and would prefer to follow patients in collaboration with a cancer center. The survey results are published in the Annals of Internal Medicine.
Between September 2011 and August 2012, 1,801 general internists were mailed a cross-sectional survey to determine their knowledge about the care of adult childhood cancer survivors; of these, 1,110 responded. The survey asked the physicians about their comfort levels caring for adult childhood cancer survivors and their familiarity with available surveillance guidelines (Likert score ≥ 5). To assess their knowledge of surveillance guidelines, physicians were given a clinical vignette describing the hypothetical case of a young adult female survivor of Hodgkin lymphoma.
Survey Findings
On average, internists reported being “somewhat uncomfortable” caring for adult childhood cancer survivors. Only 36.9%, 27%, and 25% of respondents reported they were “somewhat comfortable” or “comfortable” caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma, respectively.
In multivariate analyses, comfort levels were higher among internists with a larger patient volume, those who had seen at least one adult childhood cancer survivor in the preceding 5 years, and those who were male.
The internists reported being generally unfamiliar with available surveillance guidelines for adult childhood cancer survivors, with only 12% stating that they felt at least “somewhat familiar” with available guidelines and only 5.4% of respondents answered three questions about COG surveillance guidelines correctly. For example, COG guidelines recommend annual mammograms and breast MRI screenings for survivors of Hodgkin lymphoma, but just 17.8% of respondents recommended annual mammograms and only 9.4% recommended annual breast MRIs for these patients.
Collaboration With an Oncologist
Most respondents (84%) said they would prefer to work collaboratively with a physician based at a cancer center or a long-term follow-up clinic when caring for an adult survivor of childhood cancer, and 10.5% said they would refer these patients to a cancer center–based physician, long-term follow-up program, or another primary care physician. However, despite 51% of respondents reporting having cared for at least one adult childhood cancer survivor in the past 5 years, only 25% said they had received a treatment summary for the patient from the oncology center.
Next Steps
To improve the knowledge gap general internists have of available guidelines for late- effects surveillance, the study authors recommend enhanced education of primary care physicians through webinars, education sessions at national meetings, and guidelines linked to internal medicine websites. They also suggest that efforts be made to improve the comanagement of patients by oncologists and primary care physicians from cancer diagnosis through survivorship.
Tara O. Henderson, MD, MPH, of the University of Chicago Medicine Comer Children’s Hospital, is the corresponding author for the Annals of Oncology article.
The study was funded by the National Cancer Institute.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
