Self-Reported Health Problems of Young Adults in Clinical Settings: Survivors of Childhood Cancer and Healthy Controls

The Journal of the American Board of Family Medicine

Lisa A. Schwartz²  Claire A. Carlson²  Jun J. Mao¹  Branlyn W. DeRosa²  Jill P. Ginsberg²  Sue K. Ogle²  Wendy L. Hobbie²  Anne E. Kazak²  Ifigenia D. Mougianis² 

[1] Department of Family Medicine and Community Health (JJM), University of Pennsylvania School of Medicine, Philadelphia;From the Division of Oncology, The Children`s Hospital of Philadelphia, Pennsylvania (LAS, BWD, JPG, WLH, CAC, IDM, SKO, AEK)

关键词: Checklist;    Young Adult;    Primary Health Care;    Child;    Cancer;    Cancer Survivorship;   

DOI  :  10.3122/jabfm.2010.03.090215

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Increasing numbers of childhood cancer survivors are being seen in primary care settings as young adults. It is unknown how their self-reported health problems differ from those of healthy young adults. Self-reported health problems of cancer survivors and healthy controls are compared in this study.

Methods: 156 cancer survivors visiting a cancer survivorship program and 138 controls in primary care centers (mean age, 20 years) completed the Health Knowledge Inventory, a checklist of 35 health problems.

Results: Cancer survivors reported significantly more health problems than healthy controls (5.6 vs 2.6 problems; P < .001). For cancer survivors, more intense treatment and older age related to Organic/Major problems and Constitutional/Other problems. Female sex related to report of Organic/Major problems and Constitutional/Other problems for the controls. Although at least 20% of both healthy controls and survivors endorsed dermatologic, headache, gastrointestinal, and weight problems, survivors endorsed growth, thyroid, kidney, immunologic, heart, and fertility problems 4-fold over controls.

Conclusions: Cancer survivors endorse significantly more health problems than do healthy controls. However, some problems are reported with equal frequency among the groups. Understanding these similarities and differences between survivors and healthy controls will facilitate patient-centered comprehensive care for young-adult cancer survivors.

• Checklist
• Young Adult
• Primary Health Care
• Child
• Cancer
• Cancer Survivorship

Given significant treatment advances in recent decades, the survival rate for pediatric cancer exceeds 75% and 1 out of every 640 young adults is a pediatric cancer survivor.^1,2 Despite being cured, childhood cancer survivors experience or are at risk for sequelae of their disease or treatment (ie, late effects) that often do not appear until adulthood.³ Late effects may be medical (eg, cardiovascular, pulmonary, renal, musculoskeletal, endocrinopathies, second cancers) or psychological (eg, cognitive, depression, posttraumatic stress).⁴ Life-long medical surveillance is necessary to manage these concerns, monitor risk for future morbidities of cancer therapy, and provide counseling about health risk and promotion behaviors to help reduce the occurrence or severity of late effects.^2,5

Unfortunately, data from the Childhood Cancer Survivorship Study (CCSS) has shown that only 35% of survivors recognize that they could have serious health problems related to their cancer treatment⁶ and more than 50% do not receive cancer-related follow-up care.⁷ Family physicians tend to see more young adults than other physician specialties and may therefore play an important role in addressing the needs of cancer survivors in this age range.^8,9 The potential benefits of involvement of a primary care physician (PCP) include continuity of care, geographic convenience, cost effectiveness, and treatment in settings that are developmentally appropriate (not pediatric) and void of negative reminders of the cancer experience. PCPs are also able to treat both cancer- and noncancer-related problems, which is especially important given predictions that the number of oncologists is insufficient to meet the needs of the increasing numbers of cancer survivors.^9,10–12 To provide optimal survivorship care, PCPs need to be knowledgeable about the health problems of cancer survivors and how survivors present their concerns relative to healthy young adults.¹¹

Although previous epidemiologic research has demonstrated that adult survivors of childhood cancer report more health problems than a sibling control,¹³ how the health problems of cancer survivors compare with unrelated young adults without a history of a chronic health condition in clinical settings is not known. In fact, little is known about the presenting problems of young adults, in general, because they are underinsured and underutilize health care.¹⁴ When young adults do seek medical care it is more likely to be initiated for a suspected problem or illness rather than a routine visit.¹⁴ Thus, because of the limited research about the health concerns of young adults, an understanding of young adult self-reported health problems during a clinical encounter would allow PCPs to effectively and efficiently probe for problems that may be common for young adults, in general, and to young-adult cancer survivors, in particular. Therefore, the aim of this study was to compare report of health problems by young adults in survivorship care to those by young adults without significant medical histories seen in primary care. We also sought to identify the relationship between clinical and demographic variables and reported problems for each group separately.

【 授权许可】

Unknown   

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