AAP updates guidelines on long-term care for cancer survivors
The AAP published updated guidelines on the long-term care of children, adolescents and young adults who survived childhood cancer.
The guidelines, which were based on guidance from the Children’s Oncology Group, include a strong recommendation that primary care providers work in tandem with their patients’ oncology specialists to conduct a plan of care as patients age.
Survivors of pediatric cancer have been known to face health issues due to adverse effects of chemotherapy and radiation, with some effects not becoming apparent until years into their remission, according to one 2020 study. This is the third edition of the guidelines, with the most prominent addition to its 2014 predecessor being that counseling increased the likelihood of scheduling cardiomyopathy screenings.
According to Melissa Hudson, MD, director of the division of cancer survivorship at St. Jude Children’s Research Hospital and corresponding author of the new guidelines, the updates are meant for primary care providers.
“Primary care providers may not be as familiar with the vulnerabilities that are associated with specific childhood cancers. We provide them a resource and some guidance about how to plan care for childhood cancer survivors,” Hudson said in an interview with Healio. “In this specific report, we went into more detail about, you know, how can one organize care beyond just guideline recommendations.”
Evidence for the guidelines came from a search of medical literature from the previous 20 years. A panel of experts in the late effects of childhood and adolescent cancer treatment reviewed and scored the guidelines using a modified version of the National Comprehensive Cancer Network Categories of Consensus system.
The additions and edits included new research related to thresholds and risk factors for cardiovascular toxicity after treatment with anthracycline chemotherapy and chest radiation, prevalence data regarding pregnancy-associated cardiomyopathy, prevalence data related to the occurrence of multiple hormonal deficiencies among survivors treated with cranial irradiation, and improved risk estimates on the contribution of radiation dose and treatment volume to risk of developing subsequent breast and colorectal carcinomas.
Most prominently, the updates asked providers to coordinate care to better serve the patient — “talking to each other and communicating and understanding the roles that are being played in that child's care,” Hudson said.
“A care plan just really encourages coordination, especially if a child has a very complicated post-cancer treatment history with a lot of morbidity,” Hudson said.