How much do doctors really know about long-term chemo?

Doctors need to be better educated about the significant long-term side effects of chemotherapy that may affect their cancer survivor patients, according to new research published Wednesday in advance of the 47th annual meeting of the American Society of Clinical Oncology (ASCO).

Currently there are at least 12 million cancer survivors in the United States. Some may have undergone cancer treatment as children; others may be older and only recently completed their cancer therapy.

While advances in cancer care have successfully kept more cancer patients alive, this new study finds there's room for improvement in their follow-up care. Primary care physicians and even cancer specialists need to be aware of the long-term effects of the drugs patients have taken to beat cancer.

Researchers at Harvard University, the National Institute of Nursing Research and the American Cancer Society surveyed nearly 1,100 primary care physicians and 1,100 oncologists or cancer specialists. They asked these doctors to identify the long-term side effects of four of the most widely used chemotherapy drugs used to treat breast and colorectal cancer, two of the most common cancers.

Overall, only 6% of primary care physicians and 65% of oncologists were aware of all the long-term side effects that the four drugs could cause.

When asked about the drug Doxorubicin, 55% of primary care physicians knew patients are at risk for cardiac dysfunction, compared to 95% of oncologists.

In the case of Cyclophosphamide, only 14% of primary care physicians knew women are likely to suffer premature menopause, compared to 71% of cancer specialists.

Study author Dr. Larissa Nekhlyudov says these physicians need to be informed about the long-term side effects of cancer treatment, "so that they may be better prepared to recognize and address these among cancer survivors."

"This is a problem of our success," says ASCO's president, Dr. Michael Link.

Dr. Neal Meropol, chief of the division of hematology and oncology at University Hospitals Case Medical Center in Cleveland, Ohio, says he's not surprised by these findings.

He says that, in the past, medical training has not been focused on making sure physicians taking care of cancer survivors are adequately prepared to deal with long-term side effects.

In addition to chemotherapy drugs and radiation treatments affecting organs and tissues, Meropol also spoke about psychosocial problems patients can face, like fear of cancer recurrence. Problems with relationships also occur because patients are no longer functioning in crisis mode and reentry into a normal pattern is sometimes very difficult.

Experts agree that in the past, the emphasis has been to keep cancer patients alive, and that entire field of cancer survivorship is a pretty new one. But with the success of cancer care, more attention must be given to this area.

Meropol points out that it's now recommended by professional societies for doctors to provide a survivorship care and treatment plan when patients complete their cancer therapy. Such a plan will inform the patient of issues they may face and they can share this information with their physician.

However this doesn't help patients who had their cancer treated a long time ago. Link, who is a pediatric oncologist, says that data among people who survived childhood cancers may be even more alarming.

That's because pediatric patients are usually treated at an age when they are too young to remember exactly what type of cancer they had or how they were treated.

"Many don't even know how to spell it," says Link. By the time they see a regular doctor as adults, the likelihood that they know how they were treated and would give their physician accurate information is pretty low.

"This is a problem we've encountered for some time [in pediatric oncology] because we've had survivors for quite some time."

Not recognizing how a cancer survivor can develop treatment-related health problems is a concern. Link calls it a doctor-education problem and a patient-education problem, which he believes could be helped by better use of electronic medical records.