A population-based study that evaluated documentation of discussions of late effects of treatment and screening recommendations between survivors of lymphoma occurring during adolescence and young adulthood (AYA) and their oncologists showed that discharge into the community without adequate direction regarding survivorship care was common. These findings were presented in the Journal of Cancer Survivorship.
Treatment of AYA patients with lymphoma frequently involves the administration of radiation therapy (RT) as well as chemotherapeutic agents such as anthracyclines and alkylators that may have serious late adverse effects, including secondary cancers, cardiovascular disease, and fertility issues, among others.
Although many studies have demonstrated suboptimal knowledge regarding survivorship care on the part of patients treated for cancer, fewer studies have examined communications related to survivorship care occurring between the treating oncologist and the patient as documented in patient medical records.
In this retrospective study, the quantity and quality of documentation of survivorship discussions between 305 AYA lymphoma survivors treated between 1984 and 2010 and their treating oncologists were reviewed using patient medical records from 6 cancer centers in British Columbia, Canada.
Of these patients, 226 had Hodgkin lymphoma and 79 had non-Hodgkin lymphoma (NHL). The median age at diagnosis was 21 years; all patients were treated with RT, and more than 90% also received chemotherapy. The median patient age was 27 years at discharge, and the median duration of follow-up was 7.2 years.
Although discussion of specific late effects of treatment was documented in the medical charts of 70% of the patients, no such documentation or only documentation of nonspecific late effects was evident for 18% and 13% of patients, respectively.
Regarding screening recommendations, documentation of a related discussion was not found in the medical charts of 47% of the patients. Furthermore, in 14% of cases where a discussion of screening recommendations was documented, the specific screening recommendation was not mentioned.
Additionally, only 42% of patients were counseled by their oncologists about their risks of a radiation-induced second cancer, and only approximately one-fourth of patients had discussions with their oncologist regarding future cancer screening to address these risks.
“[Primary care providers (PCPs)] must be equipped with adequate knowledge prior to transitioning the patient’s care to the community to enable informed survivorship care and reduce the risk of survivors being lost to follow-up,” the study authors stated.
They further noted that “the low rates of documentation of [late effect] risks and [screening recommendations] in our study support that there is a current lack of guidance provided to PCPs regarding appropriate follow-up of AYA lymphoma survivors.”
However, one encouraging finding was significantly higher rates of documentation of at least some risks of late effects of treatment (93% vs 63%; P <.0005), and some screening recommendations (65% vs 30%; P <.005), when patients discharged between 2000 and 2014 were compared with those discharged between 1985 and 1999.
In summarizing their results, study authors commented that “our study suggests that the information provided to survivors and their PCPs on [late effect] risks and [screening recommendations] is suboptimal. While information provision has increased over time, further improvement is necessary to meet the needs of both AYA lymphoma survivors and their PCPs.”
Lo AC, Samuel V, Chen B, Savage KJ, Freeman C, Goddard K. Evaluation of the discussion of late effects and screening recommendations in survivors of adolescent and young adult (AYA) lymphoma. J Cancer Surviv. Published online August 6, 2020. doi:10.1007/s11764-020-00922-7