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Pediatr Blood Cancer. 2017 Feb;64(2):353-357. doi: 10.1002/pbc.26205. Epub 2016 Aug 31.

Looking for trouble: Adherence to late-effects surveillance among childhood cancer survivors.

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Hofstra Northwell School of Medicine, Hempstead, New York.
Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York.
Divison of Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, New York.



Childhood cancer survivors (CCSs) are at high risk of morbidity and mortality from long-term complications of their cancer treatment. The Children's Oncology Group developed screening guidelines to enable the early identification of and intervention for late effects of cancer treatment. There is a paucity of data on the adherence of CCSs to screening recommendations.


A retrospective analysis of medical records to evaluate the rate of adherence of CCSs to the personalized, risk-based recommendations provided to them in the context of a structured long-term follow-up program over a 3-year period.


Two hundred eighty-six CCSs visited the survivorship clinic 542 times during the 3-year study period. The overall rate of adherence to recommended screening was 74.2%. Using a univariate model and greater age at diagnosis and at screening recommendation were associated with decreased screening adherence. Gender, cancer diagnosis, radiation therapy, anthracycline exposure, and hematopoietic stem cell transplant were not significantly associated with adherence. In a multivariate model, age over 18 years at the time of the visit was significantly associated with decreased adherence (P < 0.0329) (odds ratio: 1.53, 95% confidence interval: 1.04-2.25).


Adherence to recommended screening tests is suboptimal among CCSs, with lower rates of adherence in CCSs older than 18 years of age compared with those younger than 18 years of age. Given the morbidity and mortality from the late effects of therapy among young adult CCSs, it is critically important to identify and remove barriers to late-effects screening among CCSs.


adherence; adolescent and young adult; late effects of cancer treatment

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