Abstract
Regular follow-up care is essential for childhood cancer survivors, but we know little about physicians' experience with it. We aimed to describe: (1) involvement of Swiss physicians in follow-up care; (2) content of follow-up care provided; (3) problems encountered; and (4) additional resources needed. Within this cross-sectional survey we sent adapted questionnaires via professional associations to a sample of medical oncologists (MOs), paediatric oncologists (POs), general practitioners (GPs) and paediatricians (P) in Switzerland. Only oncologists involved in follow-up care were asked to report problems. GPs and Ps not involved in follow-up could indicate why. All physicians were asked about the content of follow-up care provided and additional resources needed. A total of 183 physicians responded (27 MO, 13 PO, 122 GP, 21 P). Involved in follow-up were 81% of MOs, 85% of POs, 39% of GPs and 81% of Ps. Follow-up content differed between oncologists (MO and PO) and generalists (GP and P), with generalists examining or informing less in regard to the former cancer. POs reported more problems than MOs: many POs reported problems with transition of survivors to adult care (91%), and because of financial resources (73%) and time restraints (73%). MOs reported most problems during transition (23%). Not being aware of a survivor was the most common reason for GPs and Ps not participating in follow-up (74%). All groups reported a need for standardised protocols (85-91%) and specialised training (55-73%). GPs (94%) and Ps (100%) additionally desired more support from oncologists. To improve quality and efficiency of follow-up care a national follow-up care model including standardised protocols and guidelines needs to be developed.
Highlights
Childhood cancer survivors are former patients who were diagnosed with cancer before the age of 15 years and have survived at least 5 years after diagnosis [1]
The working situation differed between specialisations (p
The work setting differed (p = 0.010), with oncologists working almost exclusively in urban areas (92% of medical oncologists and 100% of paediatric oncologists), compared with 69% general practitioners (GPs) and 85% paediatricians
Summary
Childhood cancer survivors are former patients who were diagnosed with cancer before the age of 15 years and have survived at least 5 years after diagnosis [1]. A recent study estimated that 95.5% of childhood cancer survivors suffered from any chronic health condition and 80.5% from a serious or life-threatening chronic condition by the age of 45 years [7] Because of this increasing population with special medical needs, many international groups advocate systematic, risk-stratified and evidence-based long-term follow-up care for childhood and AYA cancer survivors, and specific recommendations have been published [8,9,10,11,12]. This is important to prevent, or detect early, cancer recurrence, second malignancies and other health and psychosocial problems due to the cancer or its treatment [1]. Systematic implementation of these recommendations is still lacking in most countries, including Switzerland, and loss to follow-up of survivors remains a major problem [13,14,15,16]
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