Survivor profiles for health-related concerns, fears, and motivation predict participation in recommended surveillance: The Childhood Cancer Survivor Study

Background: Most adult childhood cancer survivors do not participate in recommended screening. Methods: Latent class analysis was used to categorize three different survivor groups at risk of cardiac, breast, or bone late sequelae on the basis of their health-related concerns, fears, and motivation. Survivors' age ranged from 18-52 years. Classes were compared on adherence to recommended echocardiography, mammography, and bone densitometry screening at two time points (2002, 2007) using equality of proportions. Results: Three distinct classes (worried, collaborative, self-controlling) and their covariates characterized all survivors in each of the 3 at-risk groups: cardiac (N=564; BIC=10,824.66; 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 bone density screening in 2002, compared to 17.2% in the collaborative class (p=.034); 13% of the self-controlling, 24% of the collaborative (p=.025), and 34% of the worried classes (p=.010) had participated in densitometry in 2007. While 73% of survivors in the worried class reported having had an echocardiogram in 2007, only 57% of the collaborative (p= .040) and 43% of the self-controlling (p<.001) classes did. In 2002 and 2007, respectively, fewer survivors in the self-controlling class (37% and 53%) than in the collaborative [51% (p=0.38) and 70% (p=.013)] or worried classes [58% (p=0.002) and 69% p=0.025)] had had mammograms. Conclusions: Childhood cancer survivors can be distinctively profiled. These profiles predict participation in surveillance and can be used to inform tailored nursing interventions to enhance risk-based care.