Medical screening participation in the childhood cancer survivor study.
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 < or = .001), with a sedentary lifestyle (P = .05), and less frequent health fears (P = .05) were most likely to follow the recommended echocardiogram schedule (R(2) = 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 < or = .001), and had a lower body mass index (P = .05) were most likely to adhere to the recommended bone density screening guidelines (R(2) = 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.
Cox
Cheryl L
CL
Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794, USA. cheryl.cox@stjude.org
Hudson
Melissa M
MM
Mertens
Ann
A
Oeffinger
Kevin
K
Whitton
John
J
Montgomery
Michele
M
Robison
Leslie L
LL
D000328:Adult; D015519:Bone Density; D009202:Cardiomyopathies / Q000175:diagnosis*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D009369:Neoplasms / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010024:Osteoporosis / Q000175:diagnosis*; D010349:Patient Compliance; D012307:Risk Factors; D017741:Survivors