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Most Childhood Cancer Survivors Not Monitored for Long-term Effects

Most childhood cancer survivors at risk for long-term side effects from treatment do not receive monitoring in line with care guidelines, according to a study published Sept. 17 in Pediatric Blood & Cancer. The Children’s Oncology Group has guidelines for long-term follow-up of childhood cancer survivors based on their type of cancer and the treatment they received, Healio reported. For example, those who received chest radiation are advised to undergo regular echocardiograms to watch for heart disease. Researchers looked at 253 young adult cancer survivors in the Los Angeles area. Based on the guidelines, 119 survivors should have received cardiac surveillance, 68 required thyroid surveillance and 66 should have had breast surveillance. Researchers found just around a third of survivors received the suggested monitoring (36.1% for cardiac, 31.9% for thyroid and 36.4% for breast). Survivors were more likely to receive recommended surveillance if they had health insurance and if their doctors had discussed a survivorship care plan. “Part of the issue may be that general practitioners and even nonpediatric oncologists may not be fully aware of survivorship guidelines,” Joel Milam, a study author and a cancer epidemiology researcher at UCI Chao Family Comprehensive Cancer Center in Orange, California, told Healio. “If the survivor is not aware of them and their provider is not aware of them, they likely are not getting the surveillance they need.”

Breast Cancer Screening Lags Among Transgender People

Research has found transgender women have a 46-times higher risk for breast cancer after they transition, in large part due to estrogen-containing medications, while transgender men are 60 times more likely to develop breast cancer than cisgender men. Despite these increased risks, only about a third of transgender people receive mammograms to screen for the disease, ABC News reported. “Breast cancer doesn’t care if you’re transgender, nonbinary or how you identify,” Alexes Hazen, a plastic surgeon specializing in gender-affirming procedures in New York City, told ABC News. “If you have breast tissue, you need to have [a] screening.” Experts attribute this low screening rate to lack of awareness, unclear guidelines and barriers to health care access. Breast cancer often does not come up during a transgender person’s visit with a doctor, as the conversation tends to focus on transition care, according to the ABC News report. Even when doctors do bring up breast cancer screening, guidelines offer little direction due to a lack of data about the disease in transgender individuals. Additionally, most breast cancer screening is offered in facilities designed to serve women, which can cause discomfort for transgender men. Experts hope better awareness of breast cancer risk among both the transgender community and the doctors who serve them can help increase screening rates. “Ignoring a whole sector of the population that has breast tissue is tragic and sad,” Hazen said. “The message needs to get out that screening is available, and insurance can cover it.”

People With Head and Neck Cancer at Increased Risk for Depression

People with head and neck cancer are almost twice as likely to have depression as people with other types of cancer, according to a study published in JAMA Otolaryngology—Head & Neck Surgery. However, people with head and neck cancer seek help for depression at similar rates as other cancer patients, indicating this side effect is likely undertreated in this population, Healio reported. Depression can be high in people with head and neck cancer in part because treatment can negatively impact breathing, eating and speaking. Researchers used data from a health questionnaire completed by nearly 23.5 million people with a cancer history, 377,080 of whom had head and neck cancer. Based on questionnaire scores, 40.1% of people with head and neck cancer were identified as having depression, compared with 22.3% of other cancer patients. Researchers also found self-reported rates of depression and antidepressant use were similar in both groups. “It is important for clinicians to recognize that depression may be underreported, underdiagnosed and undertreated in this population,” Michelle M. Chen, a study author and a head and neck surgical oncologist at Stanford Cancer Institute in California, told Healio.