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Specialized clinics reduce ED visits among adult survivors of pediatric cancer
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Survivors of childhood cancers who attend specialized survivor clinics for their long-term care into adulthood are less likely to visit a hospital ED than survivors who receive care from a family physician, according to results of a population-based, retrospective cohort study.
Eighty percent of children with cancer survivor into adulthood and are at risk for treatment-related adverse health outcomes. By age 50 years, more than half of childhood cancer survivors will have a condition that is considered severe, disabling or life-threatening, or, they will die prematurely, according to study background. Also, hospitalization risk is almost three times greater for survivors of childhood cancer than in the general population.
Rinku Sutradhar, PhD, MSc, assistant professor at the Institute of Health, Policy, Management and Evaluation in the Dalla Lana School of Public Health at University of Toronto, and colleagues sought to determine the effect specialized survivor clinics had on the rate of ED visits among adult survivors of childhood cancer in Ontario. The Ontario Ministry of Health and Long-Term Care funded the creation of a network of specialized clinics in Ontario in 1999 for these patients.
The investigators retrospectively analyzed a cohort of 3,912 adult survivors of childhood cancer diagnosed between January 1, 1986 and December 31, 2005.
A total of 56.7% of the patients had no visits to a survivor clinic. From that group, 40 individuals (1.8%) died during the observation period. Of those who did attend a survivor clinic, 0.7% (n = 12) died during the observation period.
Individuals who had at least one visit to a survivor clinic had a 19% decreased rate of ED visits compared with those who had not visited a clinic (adjusted relative rate = 0.81; 95% CI, 0.78-0.85). Each additional visit was associated with a 5% decrease in the rate of ED visits (adjusted relative rate = 0.95; 95% CI, 0.93-0.96). All results were independent of whether or not survivors received care from their primary care physician.
“This study… demonstrates that attendance at a specialized survivor clinic is associated with a decrease in emergency department visits,” Sutradhar and colleagues wrote. “Future work will assess other measures of health service utilization, such as hospitalization rates and the uptake of various health surveillance tests and use administrative data to determine the incidence of specific late effects of therapy and their relation to survivor clinic attendance.”
The policy, economic and clinical care implications of these findings are important and may necessitate an expansion of specialty clinics for childhood cancer survivors in the U.S., Emily S. Tonorezos, MD, MPH, and Kevin C. Oeffinger MD, both of Memorial Sloan Kettering Cancer Center, wrote in an accompanying editorial.
“We must ask whether care for adult survivors of childhood cancer is so specialized that it requires the contributions of a dedicated provider,” they wrote. “Such specialized clinics are intended not to replace care provided by a primary care clinician, but rather to complement such care through a shared-care model. [This study] makes a robust argument for this strategy.” – by Anthony SanFilippo
Disclosure: Neither the researchers nor Tonorezos nor Oeffinger report any relevant financial disclosures.
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