Creating a Medical Home for Pediatric Cancer Survivors :

A medical home is defined as an “accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective” primary care model. It “facilitate[s] essentially all aspects of pediatric care.”¹ The American Academy of Pediatrics (AAP) strongly endorses a medical home model; increasing the number of youth cared for in medical homes remains a key objective of Healthy People 2030.² Realistically, what does that look like for a child, adolescent, or young adult cancer survivor?

Advances in treatment and improved survival have resulted in approximately 500,000 pediatric cancer survivors in the United States. Unfortunately, late complications following treatment completion are common and two out of every three of these patients experience at least one physical or psychosocial late-effect requiring follow-up care. While some of this care is provided by cancer centers and survivorship clinics, adherence to recommended visits is variable and barriers to care (e.g., insurance, distance, economic) at treating institutions are common. Consequently, many pediatricians and other primary health care providers find themselves providing needed surveillance and intervention to this growing population.

Fortunately, detailed guidance in how best to care for pediatric cancer survivors is exactly what is offered by the revised clinical report by Hudson and colleagues (10.1542/peds.2021-053127). Specifically, the authors summarize how providers can utilize the Children’s Oncology Group Long-Term Follow-Up (COG LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, Version 5.0³ to provide risk-based, survivor-centered care given their patient’s diagnosis, and specific treatment history. Two illustrative case examples and seven concrete recommendations for how best to provide critical survivorship care are offered. For example, the authors emphasize development of a survivorship care plan, communication, and supporting transition to adult health care as key components of survivors’ care.

Maximizing the quality of life of pediatric cancer survivors is a goal that all can agree on. Information provided in this clinical report and reference to freely available resources (e.g., COG LTFU Guideline Health Links⁴) can facilitate providers’ provision of quality, evidence-based care and creation of a medical home that may help accomplish that goal.

References:

1. Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The medical home. Pediatrics. 2002;110:184-6.
2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Washington, DC; 2020.
3. Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers, Version 5.0. Monrovia, CA: Children's Oncology Group; 2018.
4. Eshelman D, Landier W, Sweeney T, et al. Facilitating care for childhood cancer survivors: integrating children's oncology group long-term follow-up guidelines and health links in clinical practice. J Pediatr Oncol Nurs. 2004;21:271-80.