Text Message System Uses Common Behavior to Promote, Enhance Childhood Cancer Survivorship Care

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AYA survivors reported that text messaging was a good way to communicate with their health care team.
AYA survivors reported that text messaging was a good way to communicate with their health care team.

There is one type of text messaging that some teens and young adults are actually encouraged to use: to participate in a system that improves care for adolescent and young adult (AYA) survivors of childhood cancer. More young people are surviving childhood cancers; the long-term childhood cancer survival rate is now higher than 83%.1 Thus, there is an increasingly large number of AYAs who are at risk for developing late effects from their prior cancer treatment.

Late Effect Screening: Needs and Barriers

These sequelae can be physical, psychological, or social. Chronic or late effects occur in approximately 65% of childhood cancer survivors, with approximately 30% of late effects having fatal consequences.1 The Institute of Medicine recommends life-long surveillance, prevention, and treatment of late effects as a component of survivorship care in this patient group. The survivorship care clinician should be knowledgeable about a patient's cancer treatment history, conduct a physical examination, order laboratory tests and imaging studies, and make referrals to specialists based on the patient's risk for late effects. However, this course of events does not occur for most cancer survivors, and the number of survivors who receive the recommended medical attention is negatively correlated with the number of years since diagnosis.1 This could be a real danger. Some of the late effects, such as cardiac dysfunction resulting from chemotherapy, may be asymptomatic initially, and reduction of long-term morbidity and mortality depends on early detection and treatment.

There are several age-specific barriers to ensuring early adoption of late-effect screening in AYA survivors. For example, the health care system can be fragmented and expensive. Clinicians may not be comfortable providing survivorship care for AYA survivors, or even know how to do so. In addition, survivors may not understand the problem posed by improper health behavior and the negative potential for late effects.

AYA survivors of childhood cancers are ready to move on and accept the responsibilities of work and family. Visiting a health care provider when there is no obvious need to do so is not high on anyone's list.

Utilize Established Behaviors

So how can clinicians alert these young people to their special needs in an age-appropriate way that would be acceptable to them? The answer is text messaging. 

The behavior appears to come naturally to them, is one they seem to be constantly engaged in, and will not differentiate cancer survivors from their peers. What young person does not have a mobile phone? They are ubiquitous. Of children aged 12 to 13 years, 68% use a cell phone; aged 14 to 17 years, 83% use one, and aged 18 to 24 years, 97% own a cell phone.

Text messaging is already used to send appointment reminders and other health-related messages to patients of all ages. It is effective in programs for managing diabetes, providing support for weight loss, and offering encouragement with smoking cessation. Reminders to parents using text messaging led to increased rates of immunizations in infants and adolescents, and patients on antiretroviral therapy demonstrate better viral suppression when they receive weekly text messages reminding them of their next treatment.  

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