NASHVILLE – Endocrinologists dealing with adult patients who survived cancer during childhood should ensure that they have an adequate understanding of the elevated risk that such patients are at for various endocrine conditions, such as hypogonadism, hypopituitarism, and ovarian failure.
This is according to the findings of a survey study presented at the annual meeting of the American Association of Clinical Endocrinologists by Dr. Sripriya Raman of Children’s Mercy Hospital and Clinics in Kansas City, Missouri.
“Incidences of childhood cancer have crept up from 1975 to 1995, but mortality has gone down, thanks to advancements in cancer therapy,” explained Dr. Raman. “Even among ethnic groups – whites, Hispanics, African Americans, and Asians – cancer incidence rates have either stabilized or increased slightly, which means we’re seeing more and more of these types of patients at our clinics.”
Dr. Raman and coinvestigators developed a survey of 19 questions: 10 questions on provider characteristics, 5 on demographic data, and 4 questions derived from two clinical vignettes. This survey was then sent to 294 endocrinologists belonging to either the Pediatric Endocrine Society (PES) or the AACE between October and December 2014; 274 surveys were returned either complete or near complete. Of those, 231 (84%) were from pediatric endocrinologists (PE) and 43 (16%) were from adult endocrinologists (AE).
None of the AE clinics reported having a focus clinic for childhood cancer survivors in their practices, compared with 54% of PE practices that reported having such a focus clinic (P < .001). Furthermore, 84% of practices that reported a general lack of adequate training, confidence, and general awareness of the long-term follow-up guidelines for treating childhood cancer survivors were AE, compared with 16% PE (P < .001).
Overall, 53% of practices reported receiving cancer treatment summaries for their patients on a consistent basis. Regarding the training they’ve received on how to treat childhood cancer survivors, 65% reported receiving “somewhat adequate training” but 22% reported receiving either very little or no training all. While 67% of practices reported feeling “somewhat confident” in their ability to properly treat childhood cancer survivors, 10% reported feeling either very little or no confidence. Infertility and growth hormone deficiency were the most commonly cited conditions reported by AE clinics that responded to the survey.
Of PE practices, 64% reported following at least six patients who were childhood cancer survivors, while only 19% of AE practices reported the same (P < .001). Regarding the clinical vignettes, PE practices scored higher than their AE counterparts on identifying childhood cancer survivors’ susceptibility to cranial radiation (76% vs. 50%; P = .001) and ovarian failure (28% vs. 13%; P = .048), but there was “no significant difference” in scores on the topics of hypopituitarism and hypogonadism.
Nearly 1 out of every 640 young adults in the United States are childhood cancer survivors, and roughly 40% of those will experience at least one endocrine disorder at some point in their adult life. To solve the issue of insufficient experience or preparation regarding treatment of these patients, Dr. Raman suggested that practices create personalized management plans with specific protocols derived from clinical guidelines and expert opinions. These protocols could either be cancer center based, community based, or a hybrid of the two, which would involve care at a community site along with “close collaboration with [a] cancer center.”
“There are no treatment guidelines specifically for endocrinologists,” said Dr. Raman. “There are screening guidelines, which are more guided towards oncologists [and] family practitioners who would be seeing these patients with the idea that they would be referred to endocrinologists once they identify a problem.”
Dr. Raman did not report any relevant financial disclosures.