(P 22) RECALL EXPERIENCE FOR SURVIVORS OF PEDIATRIC RHABDOMYOSARCOMA TREATED AT A SINGLE INSTITUTION BETWEEN 1970 AND 2010

Objective: To assess long-term morbidity including the risk of second malignancy in survivors of pediatric rhabdomyosarcoma treated in British Columbia (BC) between 1970 and 2010 and lost to any ongoing follow-up at an oncology center.

Methods: We attempted to contact 43 adult survivors previously treated for rhabdomyosarcoma in BC in childhood (between the ages of less than 1 and less than 18) between 1970 and 2010. This effort was part of the BC Cancer Provincial Late Effects, Assessment and Follow-up (LEAF) Clinic Program for childhood and AYA cancer survivors to better serve cancer survivors. We contacted these patients using mail initially due to ethics board concerns regarding privacy. Many letters were returned due to incorrect address information. We managed to contact only 18 patients (16 patients could not be reached and appeared to be still living in BC, 1 patient declined to attend and 8 lived out of province). The results we have pertain to those patients who were assessed.

Results: Of the 18 patients assessed, 9 had received radiation therapy (RT) in addition to chemotherapy and 9 had received chemotherapy alone with surgery for local control. The average age at the time of therapy was 7.9 years. The average age at the time of first follow-up as an adult was 37 years. Of the 9 patients assessed who had received RT, all had multiple severe late effects including hypoplasia, psychological problems (anxiety and depression) infertility and second neoplasm (4 patients - 44% of this group - developed different secondary neoplasms: I radiation induced meningioma, one renal cancer and chronic lymphocytic leukemia, and 2 patients developed squamous cell carcinoma of the vulva - leading to the death of one patient 2 years after first recall appointment. The median time between diagnosis of initial disease and diagnosis of a second neoplasm was 38 years. Of the 9 patients who received only chemotherapy and surgery, only one patient developed second malignancies (bladder cancer diagnosed 38 years after initial therapy and papillary thyroid cancer diagnosed 46 years later). Two of the patients treated with chemotherapy alone had developed infertility, but no other significant long-term morbidities were noted in the chemotherapy and surgery alone patients.

Conclusion: We successfully contacted only 18 survivors of pediatric rhabdomyosarcoma in our Province and all of those previously treated with radiation therapy (RT) had very significant late effects related to their previous therapy. It is important when discharging these patients from active clinical oncology care to communicate their significant long-term health risks to their community medical team and to the patient In view of the ongoing, high risk of long-term side effects. It is also important to try to communicate with patients treated years ago with treatment regimens that often used RT so that their follow-up is approriate. Concerns regarding the patient's ongoing health care should override those of privacy and contact should be attempted using phone calls. These patients require life-long care informed by their previous treatment exposures.