Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT)

Abstract

Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country‐specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross‐sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post‐BMT Survey, FACT‐BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment–Patient Self‐Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty‐seven percent of respondents were male, median age 54 years, and 40% were >6 years post‐BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals.

Low Rate of Cervical Cancer Screening among Women with Hematologic Malignancies after Stem Cell Transplant

“…We report that younger age was a predictor of cervical cancer screening, as reported in a previous study [13]. This may reflect that providers may be following the general population recommendations to perform cervical cancer screening more frequently in younger patients (every 3 years in women ages 21 to 29 years versus every 5 years in women aged 30 to 65 years).…”

“…Certain cancer patients who have poor expected outcomes may need a personalized approach that takes into account their long-term prognosis and weighs the costs versus benefits of cervical cancer screening. In a study surveying allogeneic bone marrow transplant recipients in Australia more than 1 year after transplant, 63.4% of female participants reported ever receiving a Pap test since transplant [13]. In another survey female SCT survivors reported Pap testing rates of 66% and 77% for patients who underwent allogeneic and autologous SCT, respectively, at any time after SCT [14].…”

“…International blood and marrow transplant societies recommend annual cervical cancer testing after SCT [12]. Suboptimal rates of cervical cancer screening have been reported through surveys conducted with survivors many years after allogeneic SCT (63% to 66% screened) [13,14] or autologous SCT (77% screened) [14]. To date, cervical screening rates and timing after SCT is not clear.…”

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

“…Adherence to recommended guidelines for health care practices in HCT long-term survivors has received sufficient investigation to indicate that important deficits exist for half of long-term survivors (107, 137). Predictors of non-adherence include lack of knowledge of recommended surveillance tests, male gender, non-white race, younger age, autologous HCT, absence of cGVHD, poorer physical functioning, longer time since HCT, and concern about medical costs.…”

Prevalence of COVID-19-related risk factors and risk of severe influenza outcomes in cancer survivors: a matched cohort study using linked English electronic health records data

“…The few previous studies in this area have reported high rates of influenza among cancer survivors, consistent with our findings, but have lacked a cancer-free comparison group. [18][19][20][21] Hermann et al investigated outcomes among patients with a history of cancer presenting with influenza, and found no difference in mortality according to haematological or non-haematological cancer type, or activity of the cancer. 18 Our results showed considerably higher risks of hospitalisation or death among haematological cancer survivors, which could be consistent with the findings in Hermann et al if haematological cancer survivors are at increased risk of infection, but not mortality once infected, compared to non-haematological cancer survivors.…”