A new retrospective cohort study has revealed concerning findings about the adherence to surveillance guidelines among adult survivors of childhood cancer in Ontario, Canada. These individuals, who face significantly elevated risks of morbidity and premature mortality due to their past cancer treatments, are not consistently following recommended surveillance protocols.
The study analysed health care administrative data for 3,241 adult survivors diagnosed between 1986 and 2014. The focus was on those at elevated risk for therapy-related colorectal cancer, breast cancer, and cardiomyopathy. Despite the high stakes, the adherence rates to the Children’s Oncology Group surveillance guidelines were alarmingly low: only 13% for colorectal cancer, 6% for breast cancer, and 53% for cardiomyopathy as of February 2020.
Over a median follow-up period of 7.8 years, the time spent adherent to recommended surveillance was equally dismal, with 14% for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. The study identified that higher comorbidity was a significant predictor of adherence across various risk groups, indicating that those with more health issues were slightly more likely to follow the guidelines.
These findings highlight a critical gap in the care of childhood cancer survivors, who often develop serious or life-threatening late effects, such as cardiomyopathy and secondary cancers. The study underscores the need for tailored interventions beyond specialised clinics to improve surveillance adherence and preventable harms among this vulnerable population.
Given the proven effectiveness of risk-adapted surveillance in reducing mortality, the researchers call for targeted efforts to increase adherence to surveillance guidelines, ensuring that survivors receive the necessary long-term follow-up care to mitigate their elevated health risks.
Reference:
Shuldiner J et al. Longitudinal adherence to surveillance for late effects of cancer treatment: a population-based study of adult survivors of childhood cancer. CMAJ. 2024;196(9):282-94.
