Health care use after diagnosis of cancer in children.

Purpose: Young patients with cancer often require extensive care during and shortly after cancer treatment for medical, psychosocial and educational problems. Approximately 85% are treated by an oncologist; however, their additional health care in this phase has barely been studied. The role of the family physician in this period is therefore unknown. Methods: We included all patients diagnosed with cancer from 1991 to 2001 under age 24 in British Columbia, Canada, and followed them from 1991 to 2006. We identified 10 controls for each case, matched by birth year and sex. Using data from the provincial health insurance plan, we determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis of the patient. Results: Seven hundred fifty-seven children were diagnosed under age 15, and 774 adolescents and young adults (AYAs) between ages 15 and 24. Half were male; the most common diagnoses were leukaemia and lymphoma. In the first 5 years after diagnosis, patients visited their family physician and noncancer specialist significantly more than controls. Younger patients had more specialist visits than AYAs, especially in the first year (on average 20 vs. 10 visits). The percentage visiting a specialist decreased faster in AYAs than in younger patients (to 49% and 76%, respectively). The most common reasons for a family physician visit were ‘neoplasm-related’ and ‘general symptoms’. The family physician was also visited for regular age-specific health problems at the same rate as controls. Specialist visits among AYAs were largely related to neoplasms, while younger patients visited their specialist for a variety of reasons. Conclusion: Both non-cancer specialists and family physicians are involved in the care for children and AYAs with cancer in the first years after diagnosis. This will facilitate transition from the clinic to long-term care, but also stresses the importance of good communication between all physicians involved. (aut. ref.)