As the number of childhood cancer survivors increases so, too, does the need to provide specialized care for them in adulthood.
Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine is addressing the need with a clinic for adult survivors of childhood cancer at the center’s south St. Louis County location. The Lifelong Outcomes Clinic, which opened Feb. 17, sees patients ages 18 and older who completed treatment for pediatric cancer two years ago or more.
The clinic provides long-term care aimed at preventing, detecting and treating delayed complications of childhood cancer and addressing the mental health concerns of adult survivors of childhood cancer.
“Adult survivors of childhood cancer and even their doctors don’t always make the connection between cancer treatment during childhood and possible complications later in life,” said Debra Spoljaric, a Washington University pediatric and family nurse practitioner who heads the clinic. “As a result, some survivors aren’t monitoring their health as they should or might not receive the care they need when health problems arise.”
More than 80 percent of people diagnosed with cancer before age 20 survive at least five years, according to the National Cancer Institute (NCI). However, three in five adults who survive childhood cancer experience ongoing health problems after treatment ends or go on to develop delayed complications, Spoljaric said. Such late effects can include infertility, heart conditions, secondary cancers and endocrine disorders related to the pituitary gland, thyroid or pancreas – even anxiety and survivor guilt.
Regular follow-up, including a physical exam, is important, she said, and will vary in frequency depending on the individual. Annual checkups will work for one, while quarterly appointments are more appropriate for another. Factors include current age and length of time since a patient completed treatment.
“We aim to prevent side effects of childhood treatment and to monitor for secondary cancers related to radiation therapy, for example,” said Spoljaric, who has expertise in caring for children and adults with cancer. “We’ll also track body mass index and other general signs of health.”
She anticipates the clinic will draw a variety of childhood cancer survivors, including those transitioning from care at Siteman Kids at St. Louis Children’s Hospital to Siteman Cancer Center for follow-up, as well as patients who haven’t sought follow-up care for years.
Spoljaric will evaluate patients and refer them to Washington University cardiologists, pulmonologists, psychologists, social workers and other experts, depending on each patient’s needs. Individuals also will receive a follow-up care plan based on the earlier cancer diagnosis and the potential late effects of cancer treatment. Such plans reflect guidance from the Children’s Oncology Group, an NCI-supported clinical trials group devoted exclusively to childhood and adolescent cancer research. A plan might include recommended screenings to assess late effects of cancer treatment. The clinic can help patients share the plans with their current physicians.
Because they were treated as children, many adult survivors of childhood cancer don’t have a full understanding of their cancer or treatment. The clinic will work with them to obtain pediatric medical records and to compile a medical history.
“Everyone, appropriately, wants to help a child facing a cancer diagnosis,” Spoljaric said. “We want to extend that same level of care and monitoring throughout a patient’s adult life.”
The Lifelong Outcomes Clinic is at Siteman Cancer Center-South County, 5225 Midamerica Plaza, St. Louis, Mo., 63129, near Interstate 55 and Butler Hill Road (map). To make an appointment, call 314-747-1171. Referrals from health-care providers are welcome, too.