Predictors of Colorectal Cancer Surveillance among Radiation-treated Survivors of Childhood Cancer

Purpose: To identify predictors of adherence to colorectal cancer (CRC) surveillance guidelines among survivors of childhood cancer who received ≥30 Gy radiotherapy to the abdomen, pelvis, or spine, and were 36 years or older at the time of last contact. Methods: We sought to identify predictors of self-reported CRC surveillance participation among 5-year survivors who completed the Childhood Cancer Survivor Study (CCSS) 2007 Follow-Up Questionnaire and met the criteria above. Univariate and multivariable generalized linear models with a log link and Poisson distribution were used to calculate relative risks (RR) with 95% confidence intervals (95% CI) for adherence to CRC surveillance guidelines (i.e., home stool blood testing and/or colonoscopy/sigmoidoscopy). Results: The mean age of 711 childhood cancer survivors eligible for the study was 44 years (SD = 5.2 years). Among them, 231 (32.5%) reported ever performing home stool blood testing and 276 (38.8%) reported ever having colonoscopy or sigmoidoscopy. Of the 711 participants, 60 (8.4%) reported home stool blood testing in the past year (meeting screening guidelines for the general adult population) and 207 (29.1%) reported having a colonoscopy or sigmoidoscopy in the past 5 years (meeting surveillance recommendations for survivors of childhood cancer treated with radiation). In the multivariable analyses, factors associated with CRC surveillance were age 50 years or older (RR = 2.4, 95% CI = 1.9–2.9); having routine cancer follow-up visit within one year prior to questionnaire completion (RR = 1.7, 95% CI = 1.2–2.5); having a physical impairment requiring the assistance of others for routine activities of daily living (RR = 1.7, 95% CI = 1.2–2.2); and having discussed future cancer risk with a physician at their most recent follow-up visit (RR = 1.3, 95% CI = 1.1–1.6). Conclusions: More than 70% of survivors at risk for CRC were not screened as recommended. Indeed, unless a physician discussed their future cancer risk, most survivors were not screened until they reached age 50, the time at which CRC screening is recommended for individuals at average CRC risk. These findings underscore the need for education of survivors and their physicians regarding the heightened CRC risk following radiation.

Duke Scholars

Author Kevin Charles Oeffinger Medicine, Medical Oncology