Risk-Based Health Care of Pediatric Cancer SurvivorsKevin Oeffinger, M.D.
Director, Living Beyond Cancer: A Program for Adult Survivors of Pediatric Cancer
Memorial Sloan-Kettering Cancer Center
New York, NY
- Currently, 78 percent of pediatric cancer patients survive more than 5 years; 1 in 640 young adults in the United States is a cancer survivor. Nonetheless, survivors face increased risk of serious health issues and increased risk of early death compared to the general population.
- Compared to their siblings without cancer, survivors are eight times more likely to develop severe or disabling conditions and five times more likely to develop multiple adverse conditions. Survivors of bone or central nervous systems cancers or Hodgkin lymphoma are at high risk for subsequent morbidity, as are survivors who have received chest radiation therapy or the chemotherapy drug bleomycin.
- Many of the health problems faced by cancer survivors are modifiable, but as time from treatment completion increases (along with the risk of late effects) visits to health professionals who could provide assistance decrease, leading to poorer health outcomes. Risk-based health care recognizes that pediatric cancer survivors are a high-risk population with a wide array of late effects, many of which are clinically latent for 20-30 years, and seeks to address potentially modifiable risk factors by secondary or tertiary prevention and early diagnosis or intervention.
- Goals of risk-based survivor care include reducing morbidity and mortality and enhancing quality of life. Elements of risk-based care include monitoring survivors for cancer recurrence, surveillance for second cancer and late effects, prevention, counseling, and education.
- Patient portals such as the Passport for Care, increased access to and sharing of medical records, standardization of screening for late effects, and development of evidence-based guidelines for survivor care and follow-up are needed to ensure optimal quality of life for this population.
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