Tailored Education Improves Awareness of Risk for Therapy-Related Complications Among Childhood Cancer Survivors
In a study reported in the Journal of Clinical Oncology, Landier et al found that education tailored to personal risk for therapy-related complications improved risk awareness in survivors of childhood cancer. The level of awareness appeared to reach a maximum after several educational sessions.
Study Details
The study involved 369 patients enrolled in the survivorship clinic at a single institution between December 2005 and September 2013 who were diagnosed with cancer at age ≤ 21 years and who had been off therapy for ≥ 2 years. Patients completed questionnaires on awareness of personal risk for therapy-related complications at T0 (first survivorship clinic visit) and subsequent visits (T1–T5).
After completing a questionnaire at each visit, patients received education tailored to their personal risk. Each patient’s responses regarding awareness of risks were compared with their actual exposure-related risks for nine therapy-related complications—cardiac dysfunction; pulmonary compromise; neurocognitive impairment; low bone mineral density; sensory impairment; renal impairment; thyroid problems; fertility problems; and subsequent malignant neoplasms. Awareness was defined as the proportion of personal risk of all complications correctly identified at each visit.
Median age at cancer diagnosis was 11 years (range = 0–21 years); median age at T0 was 24 years (range = 5–7 years). A total of 38% of patients were white, 45% had leukemia, and 34% received hematopoietic cell transplantation. Patients were at risk for a median of six (range = 1–9) complications.
Patients completed 1,248 visits (median = 3, range = 1–6). Awareness increased from 38.6% at T0 to 66.3% at T3. Generalized estimating equations adjusting for diagnosis, hematopoietic cell transplantation, race/ethnicity, and patient/parent education showed that patients had significant gains in awareness from T0 to T1 (P < .001), T1 to T2 (P = .03), and T2 to T3 (P < .001) but no significant gain thereafter through T5 (P = .7). Factors associated with low awareness included education less than a college degree (odds ratio [OR] = 1.9, P = .02), longer time from diagnosis (OR = 1.03/year, P = .04), diagnosis of leukemia (OR = 2.1, P = .004), nonwhite race (OR = 2.8, P < .001), and risk for up to six complications (OR = 2.1, P = .002).
The investigators concluded, “Risk-based education in a survivorship clinic significantly increases awareness of personal health risk through three sessions, with saturation thereafter. Vulnerable populations with minimal gain in awareness identified in this study could inform targeted interventions.”
The study was supported by the Lincy, Bandai, Hearst, Graham Family; Rite Aid; Altschul; Newman’s Own Foundations; and Sam Bottleman Estate.
Smita Bhatia, MD, of the University of Alabama at Birmingham, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
