title: Predictors of risk-based medical follow-up: a report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  The purpose of this study is to conduct an intervention study designed to assess the effectiveness of using a newsletter to increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications.
  
  
  METHODS
  Survivors participating in the Childhood Cancer Survivor Study who were at least 25 years of age and at risk of cardiovascular disease, breast cancer, or osteoporosis related to previous cancer treatment were randomly assigned to receive a newsletter featuring brief health risk information or a newsletter including an insert providing more comprehensive health risk information. A follow-up survey distributed 24 months after the newsletter intervention assessed predictors of medical follow-up.
  
  
  RESULTS
  Overall, there were no differences found among the groups in terms of access to a treatment summary, medical follow-up, discussion of childhood cancer health risks, and medical screening for the targeted health behaviors. One exception, indicating borderline significance was that women at risk for osteoporosis who received the newsletter insert were more likely to have discussed their risk with a doctor than those who only received the brief information (10.1 % vs. 4.0 % p = 0.05). Discussion of breast cancer (OR = 2.15; 95 % CI = 1.74-2.66), heart disease (OR = 5.54; 95 % CI = 4.67-6.57) and osteoporosis (OR = 10.6; 95 % CI = 8.34-13.47) risk with physician significantly predicted report of undergoing screening for targeted behavior in previous 2 years as did physician access to treatment summary.
  
  
  CONCLUSIONS
  More detailed content in a newsletter had minimal effect on recommended screening. However, survivor's discussion of cancer-related risks with one's doctor significantly influenced participation in health screening. These results highlight the integral role of communication in health behavior.
  
  
  CONCLUSIONS
  This study is designed to assess communication strategies that increase medical follow-up in pediatric cancer survivors at risk of selected treatment complications. The results are of great importance not only to the pediatric oncology community but also the broad range of adult oncology medical specialties who are directly involved in the long-term medical care of this ever increasing population of cancer survivors.
authors.affiliation: Office of Statewide Health Improvement Initiatives, Minnesota Dept. of Health, St. Paul, MN, USA.
authors.forename: Jeanne R
authors.initials: JR
authors.lastname: Steele
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.forename: Nicholas
authors.initials: N
authors.lastname: Salkowski
authors.forename: Pauline
authors.initials: P
authors.lastname: Mitby
authors.forename: Toana
authors.initials: T
authors.lastname: Kawashima
authors.forename: Mark W
authors.initials: MW
authors.lastname: Yeazel
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
mesh_terms: D000328:Adult; D017668:Age of Onset; D024221:Antineoplastic Protocols; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology; D010353:Patient Education as Topic / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data