title: Survivor typologies predict medical surveillance participation: the childhood cancer survivor study.
abstract: BACKGROUND
  Adult survivors of childhood cancer adhere poorly to recommended medical surveillance. We sought to identify modifiable factors that contribute to non-adherence.
  
  
  METHODS
  Latent class analysis categorized survivors (ages 18-52 years) at risk of cardiac, breast, or bone late sequelae on the basis of their health-related concerns, fears, and motivation. These classifications were compared at two time points for self-reported adherence to recommended echocardiography, mammography, and bone densitometry screening.
  
  
  RESULTS
  Three classes (worried, collaborative, and self-controlling) characterized survivors in each of the three risk groups: cardiac (N=564; Bayesian information criterion [BIC] =10,824.66; Lo-Mendell-Rubin parametric likelihood ratio test [LRMLRT] P= .002), breast (N=584; BIC=11,779.97; LRMLRT P< .001), and bone (N=613; BIC=11,773.56; LMRLRT P= .028). Only 9% of at-risk survivors in the self-controlling class reported undergoing bone density screening in 2005, compared with 17.2% in the collaborative class (P= .034). Thirteen percent of the self-controlling, 24% of collaborative (P= .025), and 34% of worried (P= .010) classes reported undergoing bone densitometry in 2009. Whereas 73% of at-risk survivors in the worried class reported having had an echocardiogram in 2009, only 57% of the collaborative (P= .040) and 43% of self-controlling (P< .001) classes did. In 2005 and 2009, respectively, fewer survivors in the self-controlling class (37% and 53%) than in the collaborative (51%, P= .038 and 70%, P= .01) and worried (58%, P= .002 and 69%, P= .025) classes reported undergoing mammograms.
  
  
  CONCLUSIONS
  Modifiable intrapersonal characteristics associated with these three classes predict self-reported participation in medical surveillance. Continued observation and validation of these survivor profiles may inform tailored interventions to enhance survivors' screening participation. Copyright © 2012 John Wiley & Sons, Ltd.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. cheryl.cox@stjude.org
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Cox
authors.forename: Liang
authors.initials: L
authors.lastname: Zhu
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Brenda D
authors.initials: BD
authors.lastname: Steen
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
mesh_terms: D000293:Adolescent; D000328:Adult; D015519:Bone Density; D003720:Densitometry; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009042:Motivation; D009369:Neoplasms / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult