Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
University of Ottawa, Ottawa, ON, Canada.
J Cancer Surviv. 2019 Oct;13(5):713-729. doi: 10.1007/s11764-019-00790-w. Epub 2019 Jul 24.
Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence.
We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878.
Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests.
The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population.
Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
许多儿童癌症幸存者面临癌症治疗的晚期影响的高风险，包括心脏毒性和随后的恶性肿瘤（SMN）。目前的北美指南建议定期监测这些晚期影响。我们对文献进行了系统评价，以估计遵守推荐监测的比率，并总结评估旨在提高依从性的干预措施的研究。
我们在 2000 年 1 月至 2018 年 9 月期间，在 MEDLINE、Embase、Web of Science 和 Cumulative Index of Nursing and Allied Health Literature（CINAHL）中搜索了报告心脏毒性和 SMN（乳腺癌和结直肠癌）监测依从性以及为提高推荐检测完成率而实施的干预措施的文章。使用相关的 Cochrane 清单评估偏倚风险。由于存在异质性和重叠的研究人群，我们使用叙述性综合法总结研究结果。本综述已在 PROSPERO 注册：CRD42018098878。
有 13 项研究符合评估监测依从性的纳入标准，而 5 项研究评估了提高监测率的干预措施。没有研究符合低偏倚风险的标准。推荐的筛查结直肠癌筛查（11.5-30.0%），随后是心肌病（22.3-48.1%）和乳腺癌（37.0-56.5%），完成率最低。患者-提供者沟通、参与医疗保健系统以及获得信息等因素被一致报告与更高的监测率相关。旨在提高监测率的 5 项随机对照试验中，只有 2 项显著提高了推荐检测的完成率-1 项用于超声心动图，1 项用于乳房 X 线摄影。这两项都涉及电话联系以鼓励和促进这些检查。
大多数患有心脏毒性或 SMN 高风险的儿童癌症幸存者未接受基于证据的监测。目前缺乏严格评估针对该人群提高监测率的干预措施的研究。
需要进行强有力的试验，以评估基于每个幸存者群体的独特特征和需求设计的针对性干预措施是否可以提高依从性。
