Surveillance for Second Malignant Neoplasms and Cardiac Dysfunction in Childhood Cancer Survivors

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An analysis of the Childhood Cancer Survivor Study reported in the Journal of Clinical Oncology by Yan et al found that adherence to Children’s Oncology Group (COG) recommended surveillance for second malignant neoplasms and cardiac dysfunction in high-risk childhood cancer survivors is suboptimal.

Study Details

In the analysis—conducted between 2014 and 2016—11,337 childhood cancer survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey determining adherence to COG surveillance guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to American Cancer Society (ACS) cancer screening guidelines for average-risk populations.

Adherence to Surveillance Guidelines

Patients had a median age at diagnosis of 7 years (range = 0–20.9 years), and median time from diagnosis was 29 years (range = 15–47 years).

Among high-risk survivors, adherence to COG breast, colorectal, skin, and cardiac surveillance was 12.6%, 37.0%, 22.3%, and 41.4%, respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1%, 83.6%, and 68.5%, respectively.


  • Adherence to COG surveillance recommendations was low among high-risk survivors.
  • Possession of a survivorship care plan was associated with higher adherence.

Between 2007 and 2016, adherence to COG recommendations among high-risk survivors increased from 14.3% to 41.0% (P < .001) for colorectal surveillance and from 22.4% to 38.5% (P < .001) for cardiac surveillance, and decreased from 37.9% to 13.1% (P < .001) for breast surveillance.

Overall, 27% of survivors possessed a survivorship care plan, and an additional 20.0% reported that their primary care provider was in possession of their survivorship care plan. Among high-risk survivors, having a survivorship care plan was associated with increased adherence to COG recommendations for breast (22.3% vs 8.1%, prevalence ratio [PR] = 2.52, 95% confidence interval [CI] = 1.59–4.01), skin (34.8% vs 23.0%, PR = 1.16, 95% CI = 1.01–1.33), and cardiac (67.0% vs 33.1%, PR = 1.73, 95% CI = 1.55–1.92) surveillance. For high-risk survivors, primary care provider possession of their survivorship care plan was associated with increased adherence only to COG skin cancer surveillance recommendations (36.9% vs 23.2%, PR = 1.24, 95% CI = 1.08–1.43).

The investigators concluded, “Guideline adherence is suboptimal. Although survivor survivorship care plan possession is associated with better adherence, few survivors and primary care providers have one. New strategies to improve adherence are needed.”

Adam P. Yan, MD, of The Hospital for Sick Children, Toronto, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute and the American Lebanese Syrian Associated Charities. For full disclosures of the study authors, visit

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®.