#44: Pediatric Cancer Survivorship – Focusing on Thriving, Not Just Surviving

February 16, 2022 | By Sam Masur

Summary

As more children are being cured of their childhood cancers, there is an increasing need to have additional providers comfortable with survivorship care. Join us for a radiating conversation about Cancer Survivorship with our guest, Dr. Michael Roth. He is a pediatric hematologist/oncologist and associate professor at MD Anderson Cancer Center. Dr. Roth is also the Director of the Childhood Cancer Survivorship Program and chairs the Adolescent and Young Adult Committee in the Children’s Oncology Group. We will define cancer survivorship, identify exposures that can cause chronic health issues, and address topics related to the care of survivors.

Credits

• Producer, Writer, Infographic: Christle Nwora MD
• Executive Producer: Max Cruz MD
• Showrunner: Sam Masur MD
• Cover Art: Chris Chiu MD
• Hosts: Justin Berk MD, Christle Nwora MD 
• Editor:Justin Berk MD; Clair Morgan of nodderly.com
• Guest(s): Michael Roth, MD

Cancer Survivorship Pearls

1. Cancer Survivorship is focused on long term health and quality of life. 
2. Cancer survivors are at increased risk of secondary cancers; promote healthy lifestyle choices that minimize risk. 
3. Discuss reproductive and sexual health with survivors – it matters!

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Cancer Survivorship Notes

Defining Cancer Survivorship 

Dr. Roth defines survivorship as the focus on optimizing long term health and quality of life for individuals who underwent cancer treatment at any point in their lives. The concept grew out of pediatrics as more children were cured of their initial cancers. As these children grew up, they had higher risk of heart conditions, neurocognitive conditions and other chronic health problems. 

As a provider caring for a cancer survivor, it is important to note age of treatment and type of treatment and if the patient is experiencing side effects. Primary Care Providers can lean on their patient’s survivorship clinic to help guide screening for secondary cancers and other side effects to monitor. 

Survivorship Clinic Models 

Many large pediatric cancer treatment hospitals will have a cancer survivorship clinic that is run by a pediatric trained provider (primary care, endocrinology or oncology). These clinics will see patients a few years outside of their treatment. Ages seen depends on the clinic. 

At the initial visit. Dr. Roth likes to tell families that” nothing is no longer urgent,” and that they have made it to the survivorship stage. The care provided in survivorship clinics is preventative and aimed at quality of life. The Children’s Oncology Group has clear guidelines on screening that are available to all providers. Ideally all survivorship notes are accessible to the care team. The Committee on Cancer “recommends and encourages that patients receive a survivorship care plan” (American College of Surgeons, 2021). 

Disparities in Cancer Survivorship 

There are many types of disparities in cancer survivorship care and it starts from where patients are initially seen. Dr. Roth notes that for adolescents where they present (pediatrics vs adults) can determine their experiences with survivorship clinics. Unfortunately, the same disparities seen in short-term outcomes are often mirrored in survivorship care (Murphy, 2021).  There are disparities rooted in race/ethnicity, poverty, neighborhood and types of insurance.  Dr. Roth also points out that there may be differences in not just mortality, but also morbidity. All children regardless of background deserve to have every opportunity to lead a healthy and long life post cancer treatment. 

Neurocognitive and Educational Impacts 

It is important to not only think about the neurocognitive impact of cancer treatment but also the cancer experience itself. There are some children who spend many of their formative years in a hospital or healthcare based setting who aren’t regularly interacting with their peers. Dr. Roth recommends that all cancer survivorship patients receive formal educational assessments. This especially holds true for individuals who received craniospinal radiation or spinal chemotherapy. Primary Care Providers can help patients with this process. 

Secondary Cancer Risk Reduction

Cancer survivorship patients should receive counseling on healthy diet and exercise patterns. This patient population is at higher risk for secondary cancers, so counseling against tobacco products and encouraging sunscreen is important. 

Chronic Healthcare 

Dr. Roth speaks to an aging effect he has seen in his adolescent and young adult population (Simtherman, 2020). Cancer survivors are at increased risk of developing diabetes, hypertension, metabolic syndrome, endocrine problems etc. It is important to engage allied health professionals and subspecialties for wrap-around care. 

Support for Survivors and their Families 

Peer support is an important part of recovery for many patients. With the shift towards online platforms, many survivor groups have been able to expand their reach, but Dr. Roth notes that the uptake is not universal. There are differences in demographics of the patients who participate in peer support groups. There are additional support groups for parents, but there are not enough support groups for siblings. This is an area of active research for people engaged in cancer survivorship. 

Transition of Care 

Transition to adult care for pediatric patients starts early! Increasing use of telehealth has made it easier for patients to stay in contact with their cancer survivorship clinics and still receive quality care in partnership with the primary care provider. 

Sexual Health and Fertility 

There needs to be more frank conversations about sexual health and fertility with patients (Bennedict, 2021). Dr. Roth discusses reproductive health at every visit, even with young children! These conversations are age appropriate and ensure that the patient is an active participant in their care and understands their options. There are options like sperm banking or oocyte preservation that can be offered depending on the unique clinical picture of each child. Recognize that sexuality and sexual health is important to our patients and it should be important to providers. 

High Yield Pearls

Goal

Listeners will be able to define survivorship, and identify chronic health conditions that impact survivor care.

Learning objectives

After listening to this episode listeners will be able to…  

1. Outline the goals of cancer survivorship care.
2. Describe the cancer survivorship clinic model.
3. Discuss sources of cancer survivorship disparities.
4. Identify chronic health conditions that impact cancer survivors..
5. Recognize the importance of discussing sexual and reproductive health with cancer survivors.

Disclosures

Dr Roth reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Nwora C, Roth M, Cruz M, Masur S, Chiu C, Berk J. “#44: Pediatric Cancer Survivorship – Focusing on Thriving, Not Just Surviving”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ February 16, 2022.