Predictors of risk-based medical follow-up: a report from the childhood cancer survivor study

• Authors: Jeanne R. Steele, Minnesota Department of Health; Melanie Wall, Columbia University; Nicholas Salkowski, University of Minnesota; Pauline Mitby, Children’s Hospitals and Clinics of Minnesota; Toana Kawashima, Fred Hutchinson Cancer Research Center; Mark W. Yeazel, University of Minnesota; Melissa M. Hudson, St. Jude Children’s Research Hospital; Leslie L. Robison, St. Jude Children’s Research Hospital; Ann Mertens, Emory University
• Journal Title: Journal of Cancer Survivorship
• Volume: Volume 7, Number 3
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals | 2013-09-01, Pages 379-391
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s11764-013-0280-z
• Subjects: Biology, Biostatistics; Health Sciences, Oncology
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Oncology; Social Sciences, Biomedical; Biomedical Social Sciences; Pediatric cancer; Survivorship; Late effects; Communication; ADULT SURVIVORS; HEALTH-CARE; INFORMATION; PREVENTION; SURVEILLANCE; CHALLENGES; KNOWLEDGE; EDUCATION; MESSAGES; FUTURE

Abstract

Purpose: 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. Implications for Cancer Survivors: 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.