Supportive Care in Cancer

, Volume 25, Issue 4, pp 1307–1316 | Cite as

Factors supporting cardiomyopathy screening among at-risk adult survivors of pediatric malignancies

  • Cheryl L. CoxEmail author
  • Liang Zhu
  • Rohit P. Ojha
  • Brenda D. Steen
  • Susan Ogg
  • Leslie L. Robison
  • Melissa M. Hudson
Original Article



Anthracyclines and chest irradiation place adult survivors of childhood cancer at risk of cardiomyopathy; many survivors do not obtain the recommended screening. Based on our recent clinical trial, the addition of telephone counseling to a printed survivorship care plan more than doubled survivors’ risk-based screening. Here, we sought to measure the impact of specific factors targeted in the intervention for their impact on survivors’ screening participation.


Study population—survivors participating in a randomized longitudinal intervention trial. Survivor questionnaires and medical records at baseline and 1-year follow-up provided the data. Within- and between-group differences in factors were assessed at baseline and follow-up; structural equation modeling (SEM) identified direct and indirect effects on screening participation.


Of the 411 survivors, 55.3% were female, 89.3% white, 38.9% college graduates, and age 26–59 years (mean = 41 years, SD = 7.68 years). At follow-up, the counseling group demonstrated higher scores for intent to undergo screening (p < 0.001), adherence determination (p < 0.001), autonomous regulation (p < 0.001), competency (p = 0.03), perceived effort warranted for screening (p < 0.001), and perceived value of screening (p = 0.02). SEM identified four factors that directly influenced screening participation (n = 411, RMSEA = 0.02 [90% CI = 0.000–0.05]; CFI = 0.99; TLI = 0.99; WRMR = 0.63): the counseling intervention (p < 0.0001), intrinsic motivation (p < 0.0001), competency (p < 0.0001), and decisional control (p = 0.001); intrinsic motivation was also a mediator (p = 0.002) of screening participation.


Direct interpersonal interaction that focused on multiple modifiable, autonomy-supportive factors powerfully enhances the efficacy of a print survivorship care plan in increasing survivors’ screening participation. This finding challenges providers to reach beyond the disease treatment focus and embrace these strategies in their behavior change efforts.


Cardiomyopathy Echocardiogram Survivors Pediatric cancer Late effects 


Compliance with ethical standards


NIH grants R01 NR011322 (CL Cox and MM Hudson, Co-PIs), CA55727 (GT Armstrong, PI), Cancer Center Support (CORE) grant (CA21765, C. Roberts, PI), and the American Lebanese Syrian Associated Charities (ALSAC).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The overall study was approved by the St. Jude Children’s Research Hospital Institutional Review Board and at each of the 27 participating institutions in the Childhood Cancer Survivor Study.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Cheryl L. Cox
    • 1
    Email author
  • Liang Zhu
    • 2
  • Rohit P. Ojha
    • 1
  • Brenda D. Steen
    • 3
  • Susan Ogg
    • 4
  • Leslie L. Robison
    • 1
  • Melissa M. Hudson
    • 5
  1. 1.Department of Epidemiology and Cancer ControlSt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of BiostatisticsSt. Jude Children’s Research HospitalMemphisUSA
  3. 3.Department of AnesthesiaSt. Jude Children’s Research HospitalMemphisUSA
  4. 4.Department of Nursing ResearchSt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Department of OncologySt. Jude Children’s Research HospitalMemphisUSA

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