title: Medical screening participation in the childhood cancer survivor study.
abstract: 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.
authors.affiliation: 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
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Cox
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Ann
authors.initials: A
authors.lastname: Mertens
authors.forename: Kevin
authors.initials: K
authors.lastname: Oeffinger
authors.forename: John
authors.initials: J
authors.lastname: Whitton
authors.forename: Michele
authors.initials: M
authors.lastname: Montgomery
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: 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