title: Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  Childhood cancer survivors treated with radiotherapy to a field including the colon or rectum have an elevated risk of developing radiation-induced colorectal cancer (CRC). The Children's Oncology Group recommends colonoscopy every 5 years beginning at age 35 years for at-risk survivors.
  
  
  METHODS
  Analyses included 702 five-year survivors (Childhood Cancer Survivor Study) aged ≥36 years who received ≥30 gray of abdominal, pelvic, or spinal radiotherapy. Multivariate generalized linear models were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to the Children's Oncology Group's CRC surveillance recommendations.
  
  
  RESULTS
  With a median age of 43 years (range, 36-58 years), 29.5% of the survivors (207 of 702 survivors) met surveillance recommendations. In multivariate analyses, age ≥50 years versus age 36 to 49 years (RR, 2.6; 95% CI, 2.0-3.4), reporting a routine cancer follow-up visit within 1 year before the study (RR, 1.5; 95% CI, 1.0-2.2), reporting ≥10 physician visits within the past year versus 0 to 9 visits (RR, 1.4; 95% CI, 1.1-1.7), and discussing future cancer risk with a physician at the time of the most recent follow-up visit (RR, 1.4; 95% CI, 1.1-1.7) were found to be associated with adherence to CRC surveillance recommendations.
  
  
  CONCLUSIONS
  Greater than 70% of survivors at an increased risk of CRC were not screened as recommended. Regular physician contact and discussion of screening were associated with a 60% increase in CRC surveillance. Educational interventions targeted at survivors and their primary care physicians are needed to heighten knowledge of CRC risk after radiotherapy and the importance of appropriate surveillance.
authors: Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts.
authors: Casey L
authors: CL
authors: Daniel
authors: Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Connie L
authors: CL
authors: Kohler
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Kayla L
authors: KL
authors: Stratton
authors: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Kevin C
authors: KC
authors: Oeffinger
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.|Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Wendy M
authors: WM
authors: Leisenring
authors: Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: John W
authors: JW
authors: Waterbor
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Kimberly F
authors: KF
authors: Whelan
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Gregory T
authors: GT
authors: Armstrong
authors: Department of Pediatrics, University of Chicago, Chicago, Illinois.
authors: Tara O
authors: TO
authors: Henderson
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Kevin R
authors: KR
authors: Krull
authors: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Leslie L
authors: LL
authors: Robison
authors: Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Paul C
authors: PC
authors: Nathan
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000517:prevention & control / Q000532:radiotherapy*; D055088:Early Detection of Cancer; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017741:Survivors; D014481:United States / Q000453:epidemiology
keywords: childhood cancer; colorectal; screening; survivor
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