Emory University School of Medicine, Atlanta, GA, USA.
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 2015 Uppergate Dr, GA, Atlanta, 30322, USA.
J Cancer Surviv. 2023 Apr;17(2):342-350. doi: 10.1007/s11764-023-01351-y. Epub 2023 Mar 4.
Pediatric healthcare systems must support childhood cancer survivors to optimize their transition to adult care. This study aimed to assess the state of healthcare transition services provided by Children's Oncology Group (COG) institutions.
A 190-question online survey was distributed to 209 COG institutions to assess survivor services, including transition practices, barriers, and implementation of services aligned with the six core elements of Health Care Transition 2.0 from the US Center for Health Care Transition Improvement.
Representatives from 137 COG sites reported on institutional transition practices. Two-thirds (66.4%) of site discharge survivors to another institution for cancer-related follow-up care in adulthood. Transfer to primary care (33.6%) was a commonly reported model of care for young adult-aged survivors. Site transfer at ≤ 18 years (8.0%), ≤ 21 years (13.1%), ≤ 25 years (7.3%), ≥ 26 years (12.4%), or when survivors are "ready" (25.5%). Few institutions reported offering services aligned with the structured transition process from the six core elements (Median = 1, Mean = 1.56, SD = 1.54, range: 0-5). The most prevalent barriers to transitioning survivors to adult care were perceived lack of late-effects knowledge among clinicians (39.6%) and perceived lack of survivor desire to transfer care (31.9%).
Most COG institutions transfer adult-aged survivors of childhood cancer elsewhere for survivor care, yet few programs report delivering recognized standards for quality healthcare transition programming to support survivors.
Development of best practices for survivor transition is needed to help promote increased early detection and treatment of late effects among adult survivors of childhood cancer.
儿科医疗保健系统必须为儿童癌症幸存者提供支持，以优化他们向成人护理的过渡。本研究旨在评估儿童肿瘤学组（COG）机构提供的医疗过渡服务状况。
向 209 家 COG 机构分发了一份包含 190 个问题的在线调查，以评估幸存者服务，包括过渡实践、障碍以及与美国医疗过渡改进中心的健康保健过渡 2.0 的六个核心要素相一致的服务实施情况。
来自 137 个 COG 站点的代表报告了机构过渡实践。三分之二（66.4%）的站点将癌症相关的成年后随访幸存者转移到另一家机构。向初级保健机构的转移（33.6%）是一种常见的年轻成年幸存者护理模式。站点转移在≤18 岁（8.0%）、≤21 岁（13.1%）、≤25 岁（7.3%）、≥26 岁（12.4%）或当幸存者“准备好”时（25.5%）。很少有机构报告提供与六个核心要素的结构化过渡过程相一致的服务（中位数=1，平均值=1.56，标准差=1.54，范围：0-5）。将幸存者过渡到成人护理的最常见障碍是临床医生认为缺乏晚期效应知识（39.6%）和认为幸存者缺乏转移护理的意愿（31.9%）。
大多数 COG 机构将成年期的儿童癌症幸存者转移到其他地方接受幸存者护理，但很少有计划报告提供公认的高质量医疗过渡计划标准来支持幸存者。
需要制定幸存者过渡的最佳实践，以帮助促进对儿童癌症成年幸存者晚期效应的早期发现和治疗。
