Panels Address Physician Roles in Managing Ca Survivors


ORLANDO, FLA. — Primary care physicians and other clinicians from specialties outside of oncology can expect to find their respective roles spelled out in new guidelines under development for medical management of cancer survivors.

Among the proposals in the works is an individual “end-of-treatment summary” that would be drawn up for each patient when he or she completes treatment. This would describe the therapies delivered and enumerate the long-term responsibilities of oncologists and other physicians in monitoring the patient for late effects.

Patricia A. Ganz, M.D., discussed the guidelines at the annual meeting of the American Society of Clinical Oncology (ASCO). In an interview, she said a template is nearly complete and will be available in November when an Institute of Medicine panel is to issue its report on medical and social issues facing adult cancer survivors.

Dr. Ganz, director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center of the University of California, Los Angeles, is cochair of a new ASCO Survivorship Task Force, along with the society's incoming president, Sandra J. Horning, M.D.

The task force will hold its first formal meeting this month, outgoing ASCO president David H. Johnson, M.D., said. He also said the society's health services committee is drafting clinical practice guidelines addressing late effects of treatment, secondary malignancies, and psychosocial effects.

The Children's Oncology Group (COG) has already created a Web site,

“The biggest challenge is transitioning patients from pediatric to adult settings. We hope that the guidelines will smooth the transition somewhat,” said Dr. Bhatia, director of epidemiology and outcomes research in the pediatric division of the City of Hope Comprehensive Cancer Center in Duarte, Calif. She described the guidelines (J. Clin. Oncol. 2004;22:4979–90) and Web site in her discussion of a study that found most childhood cancer survivors had severe health problems by age 45 years.

One challenge Dr. Bhatia cited is that late effects occur many years after these patients are treated in pediatric centers. By then, they usually are cared for in general adult practices where physicians may have limited access to their histories.

She cited a study that found “only 35% of childhood cancer survivors understand that serious health problems could result from past treatment” (JAMA 2002;287:1832–9). Just 72% could report their diagnosis precisely. Although 94% knew they had chemotherapy, fewer could name chemotherapy drugs such as doxorubicin (52%) and daunomycin (30%).

Kevin C. Oeffinger, M.D., principal investigator of the new sudy, estimated that a primary care physician might have three or four pediatric cancer survivors in his or her practice. “Most primary care physicians are not aware of the population, and survivors are not aware of the risk,” said Dr. Oeffinger of the University of Texas Southwestern Medical Center at Dallas.

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