Adherence to surveillance for second malignant neoplasms and cardiac dysfunction in childhood cancer survivors: A childhood cancer survivor study

Adam P. Yan, Yan Chen, Tara O. Henderson, Kevin C. Oeffinger, Melissa M. Hudson, Todd M. Gibson, Joseph P. Neglia, Wendy M. Leisenring, Kirsten K. Ness, Jennifer S. Ford, Leslie L. Robison, Gregory T. Armstrong, Yutaka Yasui, Paul C. Nathan

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


PURPOSE To evaluate childhood cancer survivors’ adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence. METHODS Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey ascertaining adherence to Children’s Oncology Group (COG) guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to the American Cancer Society (ACS) cancer screening guidelines for average-risk populations. Adherence rates and factors affecting adherence were analyzed. RESULTS Median age at diagnosis was 7 years (range, 0-20.9 years), and median time from diagnosis was 29 years (range, 15-47 years). Among high-risk survivors, adherence to COG breast, colorectal, skin, and cardiac surveillance was 12.6% (95% CI, 10.0% to 15.3%), 37.0% (34.1% to 39.9%), 22.3% (21.2% to 23.4%), and 41.4% (40.1% to 42.7%), respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1% (53.2% to 61.0%), 83.6% (82.7% to 84.5%), and 68.5% (64.7% to 72.2%), respectively. Twenty-seven percent of survivors and 20.0% of primary care providers (PCPs) had a survivorship care plan (SCP). For high-risk survivors, SCP possession was associated with increased adherence to COG breast (22.3% v. 8.1%; prevalence ratio [PR], 2.52; CI, 1.59 to 4.01), skin (34.8% v 23.0%; PR, 1.16; CI, 1.01 to 1.33), and cardiac (67.0% v 33.1%; PR, 1.73; CI, 1.55 to 1.92) surveillance. For high-risk survivors, PCP possession of a SCP was associated only with increased adherence to COG skin cancer surveillance (36.9% v 23.2%; PR, 1.24; CI, 1.08 to 1.43). CONCLUSION Guideline adherence is suboptimal. Although survivor SCP possession is associated with better adherence, few survivors and PCPs have one. New strategies to improve adherence are needed.

Original languageEnglish (US)
Pages (from-to)1711-1722
Number of pages12
JournalJournal of Clinical Oncology
Issue number15
StatePublished - Feb 19 2020

Bibliographical note

Funding Information:
The Childhood Cancer Survivor Study is a National Cancer Institute–funded resource (U24 CA55727) to promote and facilitate research among long-term survivors of cancer diagnosed during childhood and adolescence. Additional support for this research was provided by the St Jude Children’s Research Hospital Cancer Center Support Grant (P30 CA021765) and the American Lebanese Syrian Associated Charities.

Publisher Copyright:
Copyright © 2020 American Society of Clinical Oncology. All rights reserved.


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