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Abstract
Background Late effects from treatment of childhood malignancies are increasing in prevalence due to higher survival rates from childhood cancer. As a result, Late Effect follow-up clinics are experiencing greater demand. This, combined with a lack of high quality, objective data in the literature, has resulted in a recent need to validate the optimum method of long-term follow-up.
Aim To evaluate the effectiveness of the hospital-based Late Effects clinic through retrospective review of the clinical records.
Method A proforma was created to extract data from patient records. Data were collected on the treatment received, screening for specific late effects of treatment, prevalence of late effects and the route by which late effects were detected.
Results Consecutive patients (n = 151) treated for non central nervous system malignancies and attending follow-up at a Late Effects clinic were analysed. Mean time since treatment was 25 years; 4% of patients were less than 5 years post-treatment. In total 185 late effects of treatment were diagnosed in 114 patients. These were broadly categorised into second malignancies (27%), thyroid (21%), fertility (17%), renal (13%), respiratory (8%), cardiac (6%) and other endocrine effects (8%). The late effects were chiefly diagnosed by the hospital-based Late Effects clinic (63%), primary care (13%) and other secondary care clinicians (9%).
Conclusion This study found that the prevalence of cancer treatment related late effects in adult survivors of childhood cancer was high. The Late Effects clinic was the principle route by which late effects were diagnosed. Early detection of late effects is of critical importance in optimising the long-term health of cancer survivors however there is a drive to reduce hospital-based follow-up of cancer survivors due to high patient demand. Our retrospective analysis suggests that primary care based follow-up is not currently sufficiently developed to detect these late effects. This study did not compare the Late Effects clinic to other methods of follow-up or include analysis of economic data; these areas should be addressed in future work.
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