Frequently Asked Questions

 Who should come to this clinic to see Dr. Butros? 

  • Childhood cancer survivors who are at least two years off treatment and free of active cancer    
    • These survivors are no longer receiving chemotherapy or other cancer therapies  
    • The current age range served in this program for childhood cancer survivors is 2-40 years old  
  • Patients with a brain tumor that is stable, off treatment in the last two years   
  • Children ages 0-19 years with blood disorders who do not require intravenous treatments or bone marrow tests    
    • A phone consultation to the child’s primary care provider will determine whether your child will need more intensive management in a larger hematology program   
  • Children who have already received intravenous treatments and need to be followed expectantly for relapse of their hematologic condition 

 Why would I go to a pay-for-service clinic rather than an office visit paid for by my insurance?
This clinic is a very different setting than a clinic in a major medical center.  It is quiet and relaxing yet provides a physician well-versed in the care of children with cancer and blood disorders.  Dr. Butros wants to see you/your child live a long, healthy, productive life and plans to follow him/her throughout that process.

In the current state of healthcare, the co-pays are often exorbitant, and the bills for services keep coming months-years after the clinic visit.  We do not want to turn away the under- or uninsured.  We want to make it simple and affordable to provide and to get care for all.  This clinic defines up front the cost of services provided.  These charges are outlined on the website.  Dr. Butros believes in a model of care that is quality care for all.  If you feel you cannot afford the services, please contact us regardless.  We want to help.

The cancer survivor visit occurs 1-3 times per year.  Most patients will only need to come once per year.  The remainder of the care will occur in phone consultation with Dr. Butros and the primary care provider as needed.  The out of pocket cost is likely only a once yearly fee.  Dr. Butros works very hard to keep the cost of service to a minimum so that her patients can afford it, and she can sustain her practice of medicine. 

Why do I need to see a specialist now that I have completed my cancer treatment and I am in remission?
 >60% of childhood cancer survivors have at least one chronic or late-occurring complication of treatment.  Many complications are manageable with proper diagnosis of the long-term side effects. Many childhood cancer survivors are thriving members of the community with the proper support, management of side effects, and education.  Complications and side effects include, but are not limited to:

  • Emotional issues such as post-traumatic stress symptoms and disorders are not uncommon in childhood cancer survivors, but regular follow-up and support from a physician who is well versed in their history can improve the physical, emotional, and even spiritual well-being of the survivor.   In my experience, one of the most anxiety-provoking behaviors in a childhood cancer survivor or their family is to pretend that the illness never happened and wait expectantly for something “bad” to happen. 
  • Cognitive dysfunction (i.e. “chemo brain,” learning difficulties) is pervasive after cancer treatment.  Fortunately, there are many interventions to treat these issues once identified.
  • Chronic pain can result from exposure to various chemotherapies, surgeries, and radiation.  There are medications, integrative therapies, and other interventions to treat pain after cancer treatment.
  • Heart problems are an uncommon side effect of certain chemotherapies.  We screen for the particular types of heart disease in patients exposed to these chemotherapies and refer patients as needed to heart specialists in the community who are well versed in treating heart disease after chemotherapy. 
  • Hearing issues are not uncommon after childhood cancer treatment.  It’s important to screen for hearing deficits and offer treatments that can dramatically improve a child’s performance in the classroom or a young adult’s performance at work. This enables our childhood cancer survivors to have the absolute best chance for success in life and contributing to the community. 
  • Lung disease can also occur after cancer treatment.  The signs of lung disease are subtle, and it is difficult to diagnose if you do not see a doctor who is familiar with the side effects of these complicated therapy exposures.  Treatments for lung disease range from something as simple as inhalers or sleep apnea therapies to more complicated interventions.
  • Bone health issues are common in childhood cancer survivors and can be easily improved upon with vitamin supplements and exercise if diagnosed properly.
  • Fertility issues and sexual dysfunction are variable issues after childhood cancer.  Counseling to discuss premature menopause and other issues that could affect life-long decisions is important and depends on the exposures during treatment. ​​ 

Why does the first visit cost more?

The first clinic visit for a childhood cancer survivor provides you with a Personal Health Binder which includes treatment exposures such as types and doses of chemotherapy, radiation exposure, and surgeries.  This binder with the Treatment Summary is an important part of information relevant to the long-term health of any cancer survivor and requires many hours of data acquisition and analysis. 

The first clinic visit for a child/adolescent with a blood disorder involves a similar amount of time and effort in order to discuss with the child/adolescent's primary care provider the reason for the referral; the onset and progression of the blood disorder; and the treatment received thus far.  The first visit takes the longest and generally will provide the most helpful information for both Dr. Butros and the patient and patient's family.