The crucial role of primary care providers in the long-term follow-up of adult survivors of childhood cancer

Research priorities for children's cancer: a James Lind Alliance Priority Setting Partnership in the UK

OBJECTIVES

To engage children who have experienced cancer, childhood cancer survivors, their families and professionals to systematically identify and prioritise research questions about childhood cancer to inform the future research agenda.

DESIGN

James Lind Alliance Priority Setting Partnership.

SETTING

UK health service and community.

METHODS

A steering group oversaw the initiative. Potential research questions were collected in an online survey, then checked to ensure they were unanswered. Shortlisting via a second online survey identified the highest priority questions. A parallel process with children was undertaken. A final consensus workshop was held to determine the Top 10 priorities.

PARTICIPANTS

Children and survivors of childhood cancer, diagnosed before age 16, their families, friends and professionals who work with this population.

RESULTS

Four hundred and eighty-eight people submitted 1299 potential questions. These were refined into 108 unique questions; 4 were already answered and 3 were under active study, therefore, removed. Three hundred and twenty-seven respondents completed the shortlisting survey. Seventy-one children submitted questions in the children's surveys, eight children attended a workshop to prioritise these questions. The Top 5 questions from children were taken to the final workshop where 23 questions in total were discussed by 25 participants (young adults, carers and professionals). The top priority was 'can we find effective and kinder (less burdensome, more tolerable, with fewer short and long-term effects) treatments for children with cancer, including relapsed cancer?'

CONCLUSIONS

We have identified research priorities for children's cancer from the perspectives of children, survivors, their families and the professionals who care for them. Questions reflect the breadth of the cancer experience, including diagnosis, relapse, hospital experience, support during/after treatment and the long-term impact of cancer. These should inform funding of future research as they are the questions that matter most to the people who could benefit from research.

Anxiety-Related Issues in Cancer Survivorship

PURPOSE

The purpose of this qualitative study was to examine patient opinions about anxiety in cancer survivorship, particularly the role of the primary care provider in management of anxiety related to the trajectory of long-term cancer survivorship.

METHODS

Respondents to a mass email (N=22,000) were invited to participate in 1 of 3 institutional review board-approved focus group meetings. Inclusion criteria were being an adult patient older than 25 years of age, having any type of cancer diagnosis, and being at least 18 months from treatment. The following specific issues were discussed: role of the primary care provider during and after therapy; the transition to primary care after therapy was finished; and advice the survivors would give to providers and cancer survivors. Focus group meetings were audio-recorded and later transcribed and reviewed by members of the research team using constant comparison methods.

RESULTS

Three 2-hour focus groups were conducted to interview 22 cancer survivors. We found 5 main themes related to anxiety in cancer survivorship: memory of anxiety; anxiety related to possible cancer recurrence; role of close relationship with the health care provider in anxiety management; frequency of communication in reduction of anxiety symptoms; and effect of anxiety on future health decisions posttreatment.

CONCLUSIONS

Survivors described anxiety persisting throughout cancer diagnosis and treatment and well into survivorship. They reported receiving care from primary care providers as well as oncologists. Anxiety was discussed by most participants as a significant part of their experience with cancer.