Thanks to advances in treatment, most people diagnosed with a childhood cancer will become long-term survivors. However, they frequently carry considerable health risks into adulthood and by age 50, more than half will develop a severe, disabling, or life-threatening condition or die prematurely. In 1999, the Ontario government started funding a provincial network of specialized survivor clinics to address the special health needs of this patient population, including care and screening that is focused on their prior cancer and the risks of their particular cancer therapy.
“We’ve known from previous studies that patients who attend survivor clinics are significantly more likely to receive care that addresses the specific risks arising from their childhood cancer diagnosis,” says Dr. Paul Nathan, the study’s senior author, Director of the Aftercare Program in the Division of Haematology/Oncology at SickKids and an adjunct scientist at ICES. “With this study, we looked at whether these specialized survivor clinics actually improve patient health outcomes, using emergency department visits as the focus of our inquiry. This study demonstrates that these clinics do indeed reduce the need for emergency care for survivors of childhood cancers.”
The study, published September 25 in the journal Cancer, examined the health care records of nearly four thousand adult survivors of childhood cancer diagnosed in Ontario in the 20 years between 1986 and 2005.
The crude rate of emergency department visits was 47.18 (per 100 person-years) among individuals with no prior survivor clinic attendance, and this rate dropped to 39.05 (per 100 person-years) among individuals with prior survivor clinic attendance. After adjusting for known confounders, patients who had at least one prior visit to a survivor clinic had a 19 per cent decreased rate of emergency department visits compared to individuals who had not visited a survivor clinic. Each additional visit to a survivor clinic was associated with a 5 per cent decrease in the rate of subsequent emergency department visits. These results were independent of whether or not survivors received care from a primary care physician.
The researchers note that Ontario’s specialized survivor clinics do not provide primary care, nor are these clinics meant to replace care offered by a primary care practitioner.
“Based on these findings, we can confidently say that adult survivors of childhood cancer should be encouraged to receive life-long, risk-based care provided by specialized survivor clinics,” says Nathan.
About Institute for Clinical Evaluative Sciences (ICES)
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca.
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