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. 2024 Mar 10;196(9):E282-E294.
doi: 10.1503/cmaj.231358.

Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer

Jennifer Shuldiner  1 , Rinku Sutradhar  2 , Cindy Lau  2 , Nida Shah  2 , Emily Lam  2 , Noah Ivers  2 , Paul C Nathan  2
Affiliations

Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer

Jennifer Shuldiner et al. CMAJ. .

Abstract

Background: Adult survivors of childhood cancer are at elevated risk of morbidity and mortality compared to the general population, but their adherence to lifelong periodic surveillance is suboptimal. We aimed to examine adherence to surveillance guidelines for high-yield tests and identify risk factors for nonadherence in adult survivors of childhood cancer.

Methods: In this retrospective, population-based cohort study, we used health care administrative data from Ontario, Canada, to identify adult survivors of childhood cancer diagnosed between 1986 and 2014 who were at elevated risk of therapy-related colorectal cancer, breast cancer, or cardiomyopathy. Using a Poisson regression framework, we assessed longitudinal adherence and predictors of adherence to the Children's Oncology Group surveillance guideline.

Results: Among 3241 survivors, 327 (10%), 234 (7%), and 3205 (99%) were at elevated risk for colorectal cancer, breast cancer, and cardiomyopathy, respectively. Within these cohorts, only 13%, 6%, and 53% were adherent to recommended surveillance as of February 2020. During a median follow-up of 7.8 years, the proportion of time spent adherent was 14% among survivors at elevated risk for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. Significant predictors of adherence varied across the risk groups, but higher comorbidity was associated with adherence to recommended surveillance.

Interpretation: Survivors of childhood cancer in Ontario are rarely up to date for recommended surveillance tests. Tailored interventions beyond specialized clinics are needed to improve surveillance adherence.

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Conflict of interest statement

Competing interests:: Jennifer Shuldiner reports receiving a Canadian Institutes of Health Research (CIHR) Health System Impact Post-doctoral Fellowship, in support of the current manuscript. Noah Ivers is supported by a CIHR Tier 2 Canada Research Chair in Implementation of Evidence-based Practice (paid to institution). Paul Nathan is supported by a CIHR Foundation Grant and a grant from the United States Department of Defense (both paid to institution). No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Flow chart for childhood cancer survivors at risk for colorectal cancer, breast cancer, and cardiac complications. Note: A survivor can be in more than 1 group, at risk for cardiac and colorectal cancer. *In earlier versions of the Children’s Oncology Group Long-Term Follow-Up guidelines, only patients who received more than the specified amount of radiation were considered at risk for colorectal cancer. In the most recent version, there is no lower radiation dose limit.
See this image and copyright information in PMC

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