PURPOSE To evaluate childhood cancer survivors' adherence to surveillance protocols for late effects of treatment and to determine the factors affecting adherence. METHODS Between 2014 and 2016, 11,337 survivors and 2,146 siblings in the Childhood Cancer Survivor Study completed a survey ascertaining adherence to Children's Oncology Group (COG) guidelines for survivors at high risk for second malignant neoplasms or cardiac dysfunction and to the American Cancer Society (ACS) cancer screening guidelines for average-risk populations. Adherence rates and factors affecting adherence were analyzed. RESULTS Median age at diagnosis was 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% (95% CI, 10.0% to 15.3%), 37.0% (34.1% to 39.9%), 22.3% (21.2% to 23.4%), and 41.4% (40.1% to 42.7%), respectively. Among average-risk survivors, adherence to ACS breast, cervical, and colorectal screening was 57.1% (53.2% to 61.0%), 83.6% (82.7% to 84.5%), and 68.5% (64.7% to 72.2%), respectively. Twenty-seven percent of survivors and 20.0% of primary care providers (PCPs) had a survivorship care plan (SCP). For high-risk survivors, SCP possession was associated with increased adherence to COG breast (22.3% v. 8.1%; prevalence ratio [PR], 2.52; CI, 1.59 to 4.01), skin (34.8% v 23.0%; PR, 1.16; CI, 1.01 to 1.33), and cardiac (67.0% v 33.1%; PR, 1.73; CI, 1.55 to 1.92) surveillance. For high-risk survivors, PCP possession of a SCP was associated only with increased adherence to COG skin cancer surveillance (36.9% v 23.2%; PR, 1.24; CI, 1.08 to 1.43). CONCLUSION Guideline adherence is suboptimal. Although survivor SCP possession is associated with better adherence, few survivors and PCPs have one. New strategies to improve adherence are needed.

中文翻译：

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遵守儿童癌症幸存者第二恶性肿瘤和心脏功能障碍的监测：儿童癌症幸存者研究

目的 评估儿童癌症幸存者对治疗后期效果监测方案的依从性，并确定影响依从性的因素。方法 2014 年至 2016 年间，儿童癌症幸存者研究中的 11,337 名幸存者和 2,146 名兄弟姐妹完成了一项调查，以确定是否遵守儿童肿瘤学组 (COG) 针对第二恶性肿瘤或心脏功能障碍高风险幸存者的指南以及美国癌症协会 (ACS) ）针对平均风险人群的癌症筛查指南。分析依从率和影响依从性的因素。结果 诊断时的中位年龄为 7 岁（范围，0-20.9 岁），诊断后的中位时间为 29 岁（范围，15-47 岁）。在高危幸存者中，坚持 COG 乳房、结直肠、皮肤和心脏监测的比例分别为 12.6%（95% CI，10.0% 至 15.3%）、37.0%（34.1% 至 39.9%）、22.3%（21.2% 至 23.4%）。 %）和 41.4%（40.1% 至 42.7%）。在平均风险幸存者中，坚持 ACS 乳腺、宫颈和结直肠筛查的比例分别为 57.1%（53.2% 至 61.0%）、83.6%（82.7% 至 84.5%）和 68.5%（64.7% 至 72.2%）。27% 的幸存者和 20.0% 的初级保健提供者 (PCP) 制定了幸存者护理计划 (SCP)。对于高危幸存者，持有 SCP 与 COG 乳房（22.3% vs. 8.1%；患病率 [PR]，2.52；CI，1.59 至 4.01）、皮肤（34.8% vs 23.0%；PR，1.16）的依从性增加相关。 ；CI，1.01 至 1.33）和心脏（67.0% vs 33.1%；PR，1.73；CI，1.55 至 1.92）监测。对于高危幸存者，PCP 拥有 SCP 仅与 COG 皮肤癌监测依从性增加相关（36.9% vs 23.2%；PR，1.24；CI，1.08 至 1.43）。结论 指南的遵守情况并不理想。尽管幸存者拥有 SCP 与更好的依从性有关，但很少有幸存者和 PCP 拥有 SCP。需要新的策略来提高依从性。