Implementation of a clinic to facilitate the transition from pediatric to adult cancer survivorship care.

Authors

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Stephanie M Smith

Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA

Stephanie M Smith , Alexander Jin , Pam Simon , Alison Clayton , Catherine Benedict , Michaela Liedtke , Lori S. Muffly , Lidia Schapira

Organizations

Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, Stanford University School of Medicine, Stanford, CA, Lucile Packard Children's Hospital, Palo Alto, CA, Stanford Cancer Institute, Palo Alto, CA, Stanford University School of Medicine, Palo Alto, CA, Stanford University, Stanford, CA, Stanford University and Stanford Cancer Institute, Stanford, CA

Research Funding

Other Foundation
Teen Cancer America

Background: Transitions from pediatric to adult care settings are challenging for adults with a history of complex childhood illness such as cancer. We developed a new clinical model to support young adult survivors of leukemia and bone marrow transplant (BMT) with transitioning from pediatric to adult focused survivorship care. Methods: We established the GREAT (Getting Regular Evaluations After Treatment) survivorship clinic as a collaboration between the adolescent/young adult (AYA) cancer program, pediatric oncologists, and specialists in adult hematologic malignancies. New patient appointments consist of two back-to-back visits: (1) a medical survivorship visit with a pediatric oncologist and an oncologist who specializes in hematologic malignancies/BMT to review the treatment history, medical issues, risk of late effects, and surveillance recommendations, and (2) an AYA-focused visit with a nurse practitioner to review fertility, education/career, and psychosocial concerns. Patients receive a treatment summary through the Passport for Care, based on pediatric survivorship guidelines. The clinic team then communicates with the patient’s primary care provider (PCP) or assists the patient with finding a PCP. Results: Since August 2020, we have seen 17 patients (12 telehealth, 5 in-person, 53% male, 47% non-Hispanic white, 41% Hispanic/Latino, 12% Asian). The median age at clinic visit was 28 years (range 24-39) and median time since treatment was 15 years (range 1-29). Patients were referred through the AYA cancer program: 8 had been regularly followed in the pediatric survivorship clinic, 2 had not been seen in pediatric oncology/survivorship for many years, 3 were treated as children but most recently seen by adult oncologists, and 4 were treated by adult oncologists and referred for AYA-specific survivorship care. Twelve (71%) patients had a PCP they see regularly, while 2 did not have a PCP and 3 were not sure. Communication with PCPs consisted of faxing the clinic note and calling the PCP’s office. All PCPs were receptive and expressed interest in receiving survivorship care recommendations; some preferred to order late effects surveillance imaging/labs, while others preferred the GREAT clinic team to do so, illustrating the value of two-way communication. Thirteen (76%) patients participated in post-clinic interviews. All stated they would recommend the clinic to others. Common themes from interviews included understanding more about their past treatment and having greater confidence managing their health. Conclusions: The model for facilitating care transitions was highly regarded by young adult cancer survivors and highlights opportunities for improving self-management and care coordination. Future directions include expanding to more cancer types, addressing barriers to primary care follow-up, and exploring shared care or co-management with PCPs.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Care Delivery and Regulatory Policy

Track

Care Delivery and Quality Care

Sub Track

Care Delivery

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e13519)

DOI

10.1200/JCO.2021.39.15_suppl.e13519

Abstract #

e13519

Abstract Disclosures

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