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Cancer. 2015 Jun 1;121(11):1856-63. doi: 10.1002/cncr.29265. Epub 2015 Feb 3.

Predictors of colorectal cancer surveillance among survivors of childhood cancer treated with radiation: a report from the Childhood Cancer Survivor Study.

Author information

1
Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts.
2
Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama.
3
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
4
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
5
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
6
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
7
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
8
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
9
Department of Pediatrics, University of Chicago, Chicago, Illinois.
10
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.

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.

KEYWORDS:

childhood cancer; colorectal; screening; survivor

PMID:
25649858
PMCID:
PMC4441567
DOI:
10.1002/cncr.29265
[Indexed for MEDLINE]
Free PMC Article

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