title: Yield of screening for long-term complications using the children's oncology group long-term follow-up guidelines.
abstract: OBJECTIVE
  The Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines use consensus-based recommendations for exposure-driven, risk-based screening for early detection of long-term complications in childhood cancer survivors. However, the yield from these recommendations is not known.
  
  
  METHODS
  Survivors underwent COG-LTFU Guideline-directed screening. Yield was classified as negligible/negative (< 1%), intermediate (≥ 1% to < 10%), or high (≥ 10%). For long-term complications with high yield, logistic regression was used to identify subgroups more likely to screen positive.
  
  
  RESULTS
  Over the course of 1,188 clinic visits, 370 childhood cancer survivors (53% male; 47% Hispanic; 69% leukemia/lymphoma survivors; median age at diagnosis, 11.1 years [range, 0.3 to 21.9 years]; time from diagnosis, 10.5 years [range, 5 to 55.8 years]) underwent 4,992 screening tests. High-yield tests included thyroid function (hypothyroidism, 10.1%), audiometry (hearing loss, 22.6%), dual-energy x-ray absorptiometry scans (low bone mineral density [BMD], 23.2%), serum ferritin (iron overload, 24.0%), and pulmonary function testing/chest x-ray (pulmonary dysfunction, 84.1%). Regression analysis failed to identify subgroups more likely to result in high screening yield, with the exception of low BMD (2.5-fold increased risk for males [P = .04]; 3.3-fold increased risk for nonobese survivors [P = .01]). Screening tests with negligible/negative (< 1%) yield included complete blood counts (therapy-related leukemia), dipstick urinalysis for proteinuria and serum blood urea nitrogen/creatinine (glomerular defects), microscopic urinalysis for hematuria (hemorrhagic cystitis, bladder cancer), ECG (anthracycline-related conduction disorder), and hepatitis B and HIV serology.
  
  
  CONCLUSIONS
  Screening tests with a high yield are appropriate for risk groups targeted for screening by the COG-LTFU Guidelines. Elimination of screening tests with negligible/negative yield should be given consideration.
authors.affiliation: City of Hope, Duarte, CA 91010-3000, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Landier
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.forename: Jin
authors.initials: J
authors.lastname: Lee
authors.forename: Ola
authors.initials: O
authors.lastname: Thomas
authors.forename: F Lennie
authors.initials: FL
authors.lastname: Wong
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.forename: Claudia
authors.initials: C
authors.lastname: Herrera
authors.forename: Clare
authors.initials: C
authors.lastname: Kasper
authors.forename: Karla D
authors.initials: KD
authors.lastname: Wilson
authors.forename: Meghan
authors.initials: M
authors.lastname: Zomorodi
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult