Meeting Cancer Survivorship Needs in Hematological Malignancies Compared to Solid Malignancies: Experiences of a Primary Care-Based Survivorship Clinic

Background

Survivors of hematological malignancies and bone marrow syndromes have unique and unmet medical and psychosocial needs compared to survivors of solid tumors given heterogeneity of diseases and treatment modalities. This study evaluates the experience of an adult primary-care based cancer survivorship clinic in addressing the survivorship needs of patients with hematological malignancies and bone marrow syndromes compared to patients with solid malignancies.

Methods

We collected demographic and clinical data via electronic chart review of patients established in the Primary Care for Cancer Survivorship clinic at a large academic medical center from November 1, 2021 through November 30, 2023. Patients were classified as either having a hematological malignancy or a bone marrow syndrome, or a solid malignancy. Patients with a history of both a hematologic and solid malignancy were not included in the analysis. Statistical variables were analyzed via Fisher exact test with significance defined as p < 0.05.

Results

Patient population. A total of 207 patients were included: 64 (30.9%) patients with hematological malignancies or bone marrow syndromes (hereafter referred to as hematological malignancies) and 143 (69.1%) patients with solid malignancies. The mean (range) age of patients with hematological malignancies was 46.9 (19-88) years, and 50% were female. The mean (range) age of patients with solid malignancies was 56.8 (23-90) years, and 82.3% were female. Patients with hematological malignancies were significantly more likely to be adolescents and young adults (AYA), defined as 39 years of age or younger, compared to those with solid malignancies (p < 0.01). Overall, 23.4% of patients with hematological malignancies and 21.7% of patients with solid malignancies had active disease; the remainder were in the post-treatment phase of survivorship. The most common hematological malignancies treated were non-Hodgkin’s lymphoma (25.0%), acute myeloid leukemia (18.8%), Hodgkin’s lymphoma (14.1%), and acute lymphoblastic leukemia (10.9%). Twenty-seven hematological malignancy survivors (42.4%) underwent bone marrow transplants.

Clinical care. Surveillance for recurrence of the primary malignancy was addressed in 82.3% of patients with hematological malignancies, less commonly than for patients with solid malignancies (95.3%) (p = 0.005). Screening for secondary cancers was addressed in 87.3% of patients with hematologic malignancies, statistically comparable to 93.7% with solid malignancies. Long-term and late effects were addressed in all patients with hematological malignancies including cardiovascular risk (98.4%), mental health (76.7%), bone health (60.9%), fertility (31.3%), cancer-related fatigue (25.5%) cognitive function (23.4%) and sexual health (9.4%). Among these issues, cardiovascular risk (p = 0.03), fertility (p = 0.04), and cancer-related fatigue (p = 0.04) were significantly more likely and sexual health (p = 0.02) was significantly less likely to be addressed in patients with hematological malignancies. Fertility referrals were significantly higher for patients with hematologic malignancies (18.8%) compared to those with solid malignancies (2.8%) (p < 0.01), but not significantly different for cardiovascular, bone, mental, or cognitive health referrals. At least one other primary care problem was addressed in most patients with hematological malignancies (96.9%), which was not statically different from patients with solid malignancies (95.1%) (p = 0.72). Exercise was addressed in 37 (57.8%) and nutrition was addressed in 32 (50%) of patients with hematological malignancies, which was comparable to patients with solid malignancies. One patient with a hematological malignancy and four with solid malignancies were deceased by the study’s end.

Conclusions

Our study demonstrates the ability of a primary care-based cancer survivorship clinic to address the unique needs of patients with hematological malignancies or bone marrow syndromes both during and after treatment. While cardiovascular risk, fertility, and cancer-related fatigue were more likely to be addressed in this patient population compared to patients with solid malignancies, secondary cancer surveillance and sexual health were less likely to be addressed, reflecting unmet needs for survivorship-based clinics warranting additional attention.