Changes in health indices and behaviors in patients attending the Yale University HEROS (Health, Education, Research Outcomes for Survivors) clinic, a regional comprehensive childhood cancer survivor clinic

Specialty childhood cancer survivorship clinics have been established to screen and prevent long-term therapy-related effects. However, the merit of addressing therapy-associated health factors by a comprehensive survivor clinic, beyond usual medical care, is unknown. We sought to determine the frequency of changes in health factors in childhood cancer survivors from their initial to most recent, annual Yale HEROS visit. This retrospective cohort study included cancer patients diagnosed at an age <21 years who attended ≥2 HEROS visits from 2/2003-12/2009, who were within 3-25 years after diagnosis and who were screened and provided health information from the Children's Oncology Group Long-Term Follow-Up Guidelines. The frequency of patients with beneficial and harmful health related factors at the first and latest HEROS visit were ascertained. Beneficial health related factors included: normal body mass index, normal fasting lipids, self-reported tobacco avoidance, sun protection, daily exercise, bi-annual dental, annual opthalmology and primary physician visits. There were 101 patients eligible for analysis, aged 8-41 years, 55% female, having a mean of 2.9 visits (range 2-6). Ninety-five (94%) were in regular medical follow-up. The majority of patients (59-86%) demonstrated a beneficial factor at their initial visit. Harmful indices and behaviors became beneficial in 11-13% and 7-24% of patients at their latest visit, respectively. As a result, 76-93% of patients demonstrated a beneficial factor at their latest visit. Individualized screening and education at a specialized survivorship clinic resulted in an increase in many evaluated beneficial health factors, associated with therapy-related health conditions, in patients already receiving primary care.