Medical Screening Participation in the Childhood Cancer Survivor Study

Abstract

Purpose Despite their risk for serious late sequelae, childhood cancer survivors do not adhere to recommended medical screenings. We identified treatment, survivor, physician, and contextual factors that may influence survivors' adherence to recommended echocardiography and bone densitometry screening. Methods Structural equation modeling of data from the Childhood Cancer Survivor Study (CCSS); participants (N=838) were diagnosed and treated for pediatric malignancies between 1970 and 1986 . Results Survivors ( Mean age = 31 years; Mean age @ diagnosis = 10 years; Mean time since diagnosis = 21 years) at risk of cardiac sequelae (N=316) who reported more cancer-related visits (P = 0.01), having discussed heart disease with a physician (P ≤ 0.001), a sedentary lifestyle (P = 0.05), and less frequent health fears (P=0.05) were most likely to follow the recommended echocardiogram schedule (R2 = 23%). Survivors (Mean age=30 years; Mean age @ diagnosis = 9 years; Mean time since diagnosis = 21 years) at risk for osteoporosis (N=324) who reported more cancer-related visits (P = 0.05), were followed up at an oncology clinic (P = 0.01), had discussed osteoporosis with a physician (P ≤ 0.001), and had a lower BMI (P = 0.05) were most likely to adhere to the recommended bone density screening guidelines (R2 = 26%). Symptoms and motivation influenced screening frequency in both models. Conclusions Multiple factors influence survivors' adherence to screening recommendations. It is likely that tailored interventions would be more successful in encouraging recommended screening among childhood cancer survivors than will traditional health education approaches.

Decreased bone mineral density and alteration in biochemical bone metabolism markers in children affected by bone tumors after completion of therapy

“…Osteoporosis has usually been considered a disease that affects the elderly, but researchers have proved that it has pediatric origins [15,[18][19]. Lim et al (16) observed that bone tumor survivors diagnosed at a young age showed a higher prevalence of osteoporosis than survivors diagnosed at an older age (37.5% vs. 10.0%).…”

Adult Cancer Survivorship: Evolution, Research, and Planning Care

“…5 Despite the availability of these guidelines and the increasing number of specialized clinics, it is estimated that fewer than 30% of survivors 20 years from diagnosis return for follow-up care, and many do not receive appropriate surveillance. 5,46,47 Children and adolescents who survive cancer grow into adulthood and then require care that focuses on their needs as adults. Many childhood cancer survivors are lost to follow-up care as they mature, leave the oversight of their parents, and take responsibility for their own medical care.…”

Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

“…28,29 Outreach and education for these providers are particularly important given the well-described association between receiving a physician recommendation for riskbased screening and completion of recommended mammogram, [30][31][32] echocardiogram, and bone density screening. 30,33 In the general population, cancer screening rates vary according to population-level factors, with lower breast cancer screening rates in communities with lower mammogram capacity, 15 and lower breast and colon cancer screening rates in communities with higher area-level poverty rates. 13 Similarly, we reported a small, but significant association between indicated echocardiography screening and both higher median income of the area of residence and greater number of physicians and surgeons, regardless of whether we adjusted for individual-level factors.…”