General internists' preferences and knowledge about the care of adult survivors of childhood cancer: a cross-sectional survey

Ann Intern Med. 2014 Jan 7;160(1):11-7. doi: 10.7326/M13-1941.


Background: Adult childhood cancer survivors (CCSs) are at high risk for illness and premature death. Little is known about the physicians who provide their routine medical care.

Objective: To determine general internists' self-reported attitudes and knowledge about the care of CCSs.

Design: Cross-sectional survey.

Setting: Mailed survey delivered between September 2011 and August 2012.

Participants: Random sample of 2000 U.S. general internists.

Measurements: Care preferences, comfort levels with caring for CCSs (7-point Likert scale: 1 = very uncomfortable, 7 = very comfortable), familiarity with available surveillance guidelines (7-point Likert scale: 1 = very unfamiliar, 7 = very familiar), and concordance with Children's Oncology Group Long-Term Follow-Up Guidelines in response to a clinical vignette.

Results: The response rate was 61.6% (1110 of 1801). More than half the internists (51.1%) reported caring for at least 1 CCS; 72.0% of these internists never received a treatment summary. On average, internists were "somewhat uncomfortable" caring for survivors of Hodgkin lymphoma, acute lymphoblastic leukemia, and osteosarcoma. Internists reported being "somewhat unfamiliar" with available surveillance guidelines. In response to a clinical vignette about a young adult survivor of Hodgkin lymphoma, 90.6% of respondents did not appropriately recommend yearly breast cancer surveillance, 85.1% did not appropriately recommended cardiac surveillance, and 23.6% did not appropriately recommend yearly thyroid surveillance. Access to surveillance guidelines and treatment summaries were identified as the most useful resources for caring for CCSs.

Limitation: Findings, based on self-report, may not reflect actual clinical practice.

Conclusion: Although most general internists report involvement in the care of CCSs, many seem unfamiliar with available surveillance guidelines and would prefer to follow patients in collaboration with a cancer center.

Primary funding source: National Cancer Institute.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Child
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence
  • Humans
  • Internal Medicine
  • Male
  • Middle Aged
  • Neoplasms*
  • Physicians, Primary Care
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'*
  • Surveys and Questionnaires
  • Survivors / statistics & numerical data*