Supporting breast self-examination in female childhood cancer survivors: a secondary analysis of a behavioral intervention.

PURPOSE/OBJECTIVES: To identify intervention targets that will increase the frequency of breast self-examination (BSE) in female survivors of childhood cancer.

DESIGN

Secondary data analysis of longitudinal clinical trial data.

SETTING

Outpatient clinic in a children's research hospital.

SAMPLE

149 female survivors (aged 12-18 years) a median of 11 years after diagnosis of leukemia or lymphoma (59%) or solid tumor (41%).

METHODS

Paired t tests, Wilcoxon signed rank tests, repeated measures analysis of variance, and analysis of covariance.

MAIN RESEARCH VARIABLES

BSE frequency, health risk perceptions, motivation, and fears or worries.

FINDINGS

Baseline BSE frequency was the strongest influence on follow-up BSE. Baseline and follow-up age and school grade influenced follow-up BSE. Other influential variables included motivation for behavior change, motivation to commit to health promotion, concern about appearance, and an interaction between the intervention and mother's highest grade level. When baseline BSE frequency and school grade were statistically controlled, diagnosis and significant interactions between grade level and the follow-up measures of the mother's education, general fears about cancer, fears about cancer returning, and perceptions of susceptibility to late treatment effects were significant influences on BSE after intervention.

CONCLUSIONS

Survivors least likely to perform BSE are fearful about cancer and are not motivated to change health behaviors.

IMPLICATIONS FOR NURSING

Nurses should explore survivors' fears about cancer and late treatment effects to address misconceptions, use modeling techniques with return demonstrations to ensure competency in BSE, and tailor risk information to each survivor's background (socio-economic status, age, development) and cognitive (disease and treatment knowledge, risks) and affective (fears) characteristics to increase BSE motivation.