Follow up for childhood cancer survivors needs clarification
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《英国医生杂志》
London
Cancer Research UK has called for guidelines on the long term follow up of survivors of childhood cancer, after a study commissioned by the charity found extensive variation in the way these patients are monitored in later life.
Survival prospects in most childhood cancers have been improving for decades, with the result that long term survivors today make up about 1 in 1000 of the adult population. Some estimates suggest that up to 70% will develop late adverse health outcomes relating to their cancer treatment, including cardiac and endocrine problems. A team of researchers from several hospitals questioned specialists and GPs about these patients' follow up on behalf of the Late Effects Group of the United Kingdom Children's Cancer Study Group (UKCCSG).
The researchers questioned clinicians who treated patients in the ongoing British childhood cancer survivor study, a population based cohort study of 14 392 survivors of childhood cancer in Britain who are aged at least 16 years. It is published in the current issue of the journal Pediatric Blood and Cancer ( 2004;42: 161-8).
According to the GPs of 10 979 childhood cancer survivors, 65% of these patients are no longer on regular long term hospital follow up. The trend, however, is towards more follow up. Among the most recent cohort of patients, who were treated as paediatric patients for cancer in 1990-1, 63% are still receiving follow up, compared with only 9% of those whose disease was treated in the 1950s.
Overall, 97% of 71 specialist clinicians questioned said they followed up paediatric cancer patients for at least five years. After five years, 52% of the clinicians continued to follow up all their patients for life, but 45% discharged some of their patients, nearly always to the patient's GP.
The authors do not speculate on whether patients are at risk due to insufficient follow up, partly because no clear picture exists of the real late effects of childhood cancer and its successful treatment. A review of evidence on late effects should be published soon by the Scottish Intercollegiate Guidelines Network.(Owen Dyer)
Cancer Research UK has called for guidelines on the long term follow up of survivors of childhood cancer, after a study commissioned by the charity found extensive variation in the way these patients are monitored in later life.
Survival prospects in most childhood cancers have been improving for decades, with the result that long term survivors today make up about 1 in 1000 of the adult population. Some estimates suggest that up to 70% will develop late adverse health outcomes relating to their cancer treatment, including cardiac and endocrine problems. A team of researchers from several hospitals questioned specialists and GPs about these patients' follow up on behalf of the Late Effects Group of the United Kingdom Children's Cancer Study Group (UKCCSG).
The researchers questioned clinicians who treated patients in the ongoing British childhood cancer survivor study, a population based cohort study of 14 392 survivors of childhood cancer in Britain who are aged at least 16 years. It is published in the current issue of the journal Pediatric Blood and Cancer ( 2004;42: 161-8).
According to the GPs of 10 979 childhood cancer survivors, 65% of these patients are no longer on regular long term hospital follow up. The trend, however, is towards more follow up. Among the most recent cohort of patients, who were treated as paediatric patients for cancer in 1990-1, 63% are still receiving follow up, compared with only 9% of those whose disease was treated in the 1950s.
Overall, 97% of 71 specialist clinicians questioned said they followed up paediatric cancer patients for at least five years. After five years, 52% of the clinicians continued to follow up all their patients for life, but 45% discharged some of their patients, nearly always to the patient's GP.
The authors do not speculate on whether patients are at risk due to insufficient follow up, partly because no clear picture exists of the real late effects of childhood cancer and its successful treatment. A review of evidence on late effects should be published soon by the Scottish Intercollegiate Guidelines Network.(Owen Dyer)