Guidelines, such as those developed by the Children's Oncology Group, can prove a useful resource to monitor and/or treat adults who have previously been treated for a pediatric cancer.
General practitioners face a dilemma. In a recent survey (Ann Intern Med. 2014;160:11-17), most reported being unfamiliar with the guidelines and uncomfortable treating adult survivors of childhood cancer; however, they can expect to see more such patients each year as treatments for childhood cancer become increasingly successful.
Several measures can help internists when such patients come into their practice, according to Lisa Diller, MD, chief medical officer of the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and founder and director of the David B. Perini Jr. Quality of Life Clinic.
"It's hard," Dr. Diller told Medscape Medical News. "The patient is worried about relapse, and sometimes relapse can present with very common symptoms, such as back pain." Internists can worry about missing an important development and overtest, or miss the red flags raised by the seeming pedestrian nature of some symptoms. Even then, not all back pain is a warning sign, she explained.
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