Survivor typologies predict medical surveillance participation: the childhood cancer survivor study

Psychooncology. 2013 Jul;22(7):1534-42. doi: 10.1002/pon.3167. Epub 2012 Sep 11.


Background: Adult survivors of childhood cancer adhere poorly to recommended medical surveillance. We sought to identify modifiable factors that contribute to non-adherence.

Methods: Latent class analysis categorized survivors (ages 18-52 years) at risk of cardiac, breast, or bone late sequelae on the basis of their health-related concerns, fears, and motivation. These classifications were compared at two time points for self-reported adherence to recommended echocardiography, mammography, and bone densitometry screening.

Results: Three classes (worried, collaborative, and self-controlling) characterized survivors in each of the three risk groups: cardiac (N=564; Bayesian information criterion [BIC] =10,824.66; Lo-Mendell-Rubin parametric likelihood ratio test [LRMLRT] P= .002), breast (N=584; BIC=11,779.97; LRMLRT P< .001), and bone (N=613; BIC=11,773.56; LMRLRT P= .028). Only 9% of at-risk survivors in the self-controlling class reported undergoing bone density screening in 2005, compared with 17.2% in the collaborative class (P= .034). Thirteen percent of the self-controlling, 24% of collaborative (P= .025), and 34% of worried (P= .010) classes reported undergoing bone densitometry in 2009. Whereas 73% of at-risk survivors in the worried class reported having had an echocardiogram in 2009, only 57% of the collaborative (P= .040) and 43% of self-controlling (P< .001) classes did. In 2005 and 2009, respectively, fewer survivors in the self-controlling class (37% and 53%) than in the collaborative (51%, P= .038 and 70%, P= .01) and worried (58%, P= .002 and 69%, P= .025) classes reported undergoing mammograms.

Conclusions: Modifiable intrapersonal characteristics associated with these three classes predict self-reported participation in medical surveillance. Continued observation and validation of these survivor profiles may inform tailored interventions to enhance survivors' screening participation. Copyright © 2012 John Wiley & Sons, Ltd.

Keywords: childhood cancer; late effects; pediatric oncology; screening.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bone Density
  • Densitometry
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mammography
  • Mass Screening / methods*
  • Middle Aged
  • Motivation
  • Neoplasms / psychology*
  • Outcome Assessment, Health Care
  • Patient Acceptance of Health Care / psychology*
  • Patient Compliance*
  • Retrospective Studies
  • Surveys and Questionnaires
  • Survivors / psychology*
  • Young Adult