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Looking for trouble: Adherence to late‐effects surveillance among childhood cancer survivors
Author(s) -
Reppucci Marina L.,
Schleien Charles L.,
Fish Jonathan D.
Publication year - 2017
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26205
Subject(s) - medicine , survivorship curve , context (archaeology) , confidence interval , medical record , cancer , multivariate analysis , odds ratio , retrospective cohort study , pediatrics , paleontology , biology
Background Childhood cancer survivors (CCSs) are at high risk of morbidity and mortality from long‐term complications of their cancer treatment. The Children's Oncology Group developed screening guidelines to enable the early identification of and intervention for late effects of cancer treatment. There is a paucity of data on the adherence of CCSs to screening recommendations. Procedure A retrospective analysis of medical records to evaluate the rate of adherence of CCSs to the personalized, risk‐based recommendations provided to them in the context of a structured long‐term follow‐up program over a 3‐year period. Results Two hundred eighty‐six CCSs visited the survivorship clinic 542 times during the 3‐year study period. The overall rate of adherence to recommended screening was 74.2%. Using a univariate model and greater age at diagnosis and at screening recommendation were associated with decreased screening adherence. Gender, cancer diagnosis, radiation therapy, anthracycline exposure, and hematopoietic stem cell transplant were not significantly associated with adherence. In a multivariate model, age over 18 years at the time of the visit was significantly associated with decreased adherence ( P < 0.0329) (odds ratio: 1.53, 95% confidence interval: 1.04–2.25). Conclusions Adherence to recommended screening tests is suboptimal among CCSs, with lower rates of adherence in CCSs older than 18 years of age compared with those younger than 18 years of age. Given the morbidity and mortality from the late effects of therapy among young adult CCSs, it is critically important to identify and remove barriers to late‐effects screening among CCSs.