Impact of Tailored Education on Awareness of Personal Risk for Therapy-Related Complications Among Childhood Cancer Survivors.
OBJECTIVE
Survivors of childhood cancer carry a substantial burden of long-term morbidity; personal risk awareness is critical to ensure survivors' engagement in early detection/management of complications. The impact of education provided in survivorship clinics on survivors' understanding of their personal health risks is unclear.


METHODS
Patients diagnosed with cancer at age 21 years or younger and at 2 or more years off therapy completed questionnaires about awareness of personal risk for therapy-related complications at T0 (first survivorship clinic visit) and at T1 to T5 (subsequent visits). After questionnaire completion at each clinic visit, survivors received education tailored to personal risk.


RESULTS
A total of 369 survivors completed 1,248 visits (median, three visits; range, one to six visits). The median age at cancer diagnosis was 11 years (range, 0 to 21 years); the median age at T0 was 24 years (range, 5 to 57 years); 38% were white; 45% had leukemia; and 34% received hematopoietic cell transplantation. The cohort was at risk for a median of six (range, one to nine) complications. Awareness increased from 38.6% at T0 to 66.3% at T3. Generalized estimating equations (that adjusted for diagnosis, hematopoietic cell transplantation, race/ethnicity, and patient/parent education) showed significant gains in awareness from T0 to T1 (P < .001), T1 to T2 (P = .03), and T2 to T3 (P < .001) but no significant gain thereafter through T5 (P = .7). Predictors of low awareness included education less than a college degree (odds ratio [OR], 1.9; P = .02), longer time from diagnosis (OR, 1.03/year; P = .04), diagnosis of leukemia (OR, 2.1; P = .004), nonwhite race (OR, 2.8; P < .001), and risk for six or fewer complications (OR, 2.1; P = .002).


CONCLUSIONS
Risk-based education in a survivorship clinic significantly increases awareness of personal health risk through three sessions, with saturation thereafter. Vulnerable populations with minimal gain in awareness identified in this study could inform targeted interventions.
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Wendy
W
Landier
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Yanjun
Y
Chen
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Golnaz
G
Namdar
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Liton
L
Francisco
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Karla
K
Wilson
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Claudia
C
Herrera
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Saro
S
Armenian
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Julie A
JA
Wolfson
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
Can-Lan
CL
Sun
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
F Lennie
FL
Wong
All authors: City of Hope, Duarte, CA; and Wendy Landier, Liton Francisco, and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL. sbhatia@peds.uab.edu.
Smita
S
Bhatia
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001364:Awareness; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D009369:Neoplasms / Q000473:pathology / Q000628:therapy*; D016017:Odds Ratio; D010353:Patient Education as Topic / Q000379:methods*; D061214:Patient Safety; D057285:Precision Medicine / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult