Survivor typologies predict medical surveillance participation: the childhood cancer survivor study


Correspondence to: St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-2794, USA. E-mail:



Adult survivors of childhood cancer adhere poorly to recommended medical surveillance. We sought to identify modifiable factors that contribute to non-adherence.


Latent class analysis categorized survivors (ages 18–52 years) at risk of cardiac, breast, or bone late sequelae on the basis of their health-related concerns, fears, and motivation. These classifications were compared at two time points for self-reported adherence to recommended echocardiography, mammography, and bone densitometry screening.


Three classes (worried, collaborative, and self-controlling) characterized survivors in each of the three risk groups: cardiac (N = 564; Bayesian information criterion [BIC] = 10,824.66; Lo–Mendell–Rubin parametric likelihood ratio test [LRMLRT] P = .002), breast (N = 584; BIC = 11,779.97; LRMLRT P < .001), and bone (N = 613; BIC = 11,773.56; LMRLRT P = .028). Only 9% of at-risk survivors in the self-controlling class reported undergoing bone density screening in 2005, compared with 17.2% in the collaborative class (P = .034). Thirteen percent of the self-controlling, 24% of collaborative (P = .025), and 34% of worried (P = .010) classes reported undergoing bone densitometry in 2009. Whereas 73% of at-risk survivors in the worried class reported having had an echocardiogram in 2009, only 57% of the collaborative (P = .040) and 43% of self-controlling (P < .001) classes did. In 2005 and 2009, respectively, fewer survivors in the self-controlling class (37% and 53%) than in the collaborative (51%, P = .038 and 70%, P = .01) and worried (58%, P = .002 and 69%, P = .025) classes reported undergoing mammograms.


Modifiable intrapersonal characteristics associated with these three classes predict self-reported participation in medical surveillance. Continued observation and validation of these survivor profiles may inform tailored interventions to enhance survivors' screening participation. Copyright © 2012 John Wiley & Sons, Ltd.