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Cheryl L. Cox, PhD; Melissa M. Hudson, MD; Ann Mertens, PhD; Kevin Oeffinger, MD; John Whitton, MS; Michele Montgomery, MPH; Leslie L. Robison, PhD

Arch Intern Med. 2009;169(5):454-462.

Background  Despite their risk for serious late sequelae, survivors of childhood cancer do not adhere to recommended medical screening guidelines. We identified treatment, survivor, physician, and contextual factors that may influence survivor adherence to recommended echocardiography and bone densitometry screening.

Methods  Structural equation modeling of data from the Childhood Cancer Survivor Study; 838 participants had received a diagnosis of and were treated for pediatric cancers between 1970 and 1986.

Results  Survivors at risk of cardiac sequelae (n = 316; mean [SD] age, 31.01 [7.40] years; age at diagnosis, 9.88 [5.88] years; and time since diagnosis, 21.14 [4.37] years) who reported more cancer-related visits (P = .01), having discussed heart disease with a physician (P  .001), with a sedentary lifestyle (P = .05), and less frequent health fears (P = .05) were most likely to follow the recommended echocardiogram schedule (R² = 23%). Survivors at risk of osteoporosis (n = 324; age, 30.20 [7.09] years; age at diagnosis, 9 .01 [5.51]years; and time since diagnosis, 21.20 [4.27] years) who reported more cancer-related visits (P = .05), were followed up at an oncology clinic (P = .01), had discussed osteoporosis with a physician (P  .001), and had a lower body mass index (P = .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 survivor adherence to screening recommendations. It is likely that tailored interventions would be more successful in encouraging recommended screening in survivors of childhood cancer than would traditional health education approaches.

Author Affiliations: Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee (Drs Cox, Hudson, and Robison and Ms Montgomery); Department of Pediatrics, Emory University, Atlanta, Georgia (Dr Mertens); Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Oeffinger); and Fred Hutchinson Cancer Research Center, Seattle, Washington (Mr Whitton).

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