Can health beliefs help in explaining attendance to follow-up care? The Swiss Childhood Cancer Survivor Study

Michel, Gisela; Kühni, Claudia; Rebholz, Cornelia; Zimmermann, Karin; Eiser, Christine; Rueegg, Corina S.; von der Weid, Nicolas X. (2011). Can health beliefs help in explaining attendance to follow-up care? The Swiss Childhood Cancer Survivor Study. Psycho-oncology, 20(10), pp. 1034-1043. Malden, Mass.: Wiley-Blackwell 10.1002/pon.1823

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Objective: Improved treatment has increased the survival of childhood cancer patients in recent decades, but follow-up care is recommended to detect and treat late effects. We investigated relationships between health beliefs and follow-up attendance in adult childhood cancer survivors.
Methods: Childhood cancer survivors aged younger than 16 years when diagnosed between 1976 and 2003, who had survived for more than 5 years and were currently aged 201 years, received a postal questionnaire. We asked survivors whether they attended follow-up in the past year. Concepts from the Health Belief Model (perceived susceptibility and severity of future late effects, potential benefits and barriers to follow-up, general health value and cues to action) were assessed. Medical information was extracted from the Swiss Childhood Cancer Registry.
Results: Of 1075 survivors (response rate 72.3%), 250 (23.3%) still attended regular followup
care. In unadjusted analyses, all health belief concepts were significantly associated with
follow-up (po0.05). Adjusting for other health beliefs, demographic, and medical variables,
only barriers (OR50.59; 95%CI: 0.43–0.82) remained significant. Younger survivors, those
with lower educational background, diagnosed at an older age, treated with chemotherapy,
radiotherapy, or bone marrow transplantation and with a relapse were more likely to attend
follow-up care.
Conclusions: Our study showed that more survivors at high risk of cancer- and treatmentrelated
late effects attend follow-up care in Switzerland. Patient-perceived barriers hinder
attendance even after accounting for medical variables. Information about the potential
effectiveness and value of follow-up needs to be available to increase the attendance among
childhood cancer survivors.

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