• Jennifer Shuldiner, Rinku Sutradhar, Cindy Lau, Nida Shah, Emily Lam, Noah Ivers, and Paul C Nathan.
• Women's College Hospital Institute for Health System Solutions and Virtual Care (Shuldiner, Ivers), Women's College Hospital; ICES Central (Sutradhar, Lau); the Hospital for Sick Children Research Institute (Shah, Lam, Nathan); Institute of Health Policy, Management and Evaluation (Ivers, Nathan), and Department of Family and Community Medicine (Ivers), University of Toronto; Division of Hematology/Oncology (Nathan), The Hospital for Sick Children, Toronto, Ont. Jennifer.Shuldiner@wchospital.ca.
• CMAJ. 2024 Mar 10; 196 (9): E282E294E282-E294.

BackgroundAdult survivors of childhood cancer are at elevated risk of morbidity and mortality compared to the general population, but their adherence to lifelong periodic surveillance is suboptimal. We aimed to examine adherence to surveillance guidelines for high-yield tests and identify risk factors for nonadherence in adult survivors of childhood cancer.MethodsIn this retrospective, population-based cohort study, we used health care administrative data from Ontario, Canada, to identify adult survivors of childhood cancer diagnosed between 1986 and 2014 who were at elevated risk of therapy-related colorectal cancer, breast cancer, or cardiomyopathy. Using a Poisson regression framework, we assessed longitudinal adherence and predictors of adherence to the Children's Oncology Group surveillance guideline.ResultsAmong 3241 survivors, 327 (10%), 234 (7%), and 3205 (99%) were at elevated risk for colorectal cancer, breast cancer, and cardiomyopathy, respectively. Within these cohorts, only 13%, 6%, and 53% were adherent to recommended surveillance as of February 2020. During a median follow-up of 7.8 years, the proportion of time spent adherent was 14% among survivors at elevated risk for colorectal cancer, 10% for breast cancer, and 43% for cardiomyopathy. Significant predictors of adherence varied across the risk groups, but higher comorbidity was associated with adherence to recommended surveillance.InterpretationSurvivors of childhood cancer in Ontario are rarely up to date for recommended surveillance tests. Tailored interventions beyond specialized clinics are needed to improve surveillance adherence.© 2024 CMA Impact Inc. or its licensors.

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