Remote Mobile Health Intervention Triples CRC Surveillance Rates in Childhood Cancer Survivors

A remote digital mobile health patient activation intervention increased the rate of colorectal cancer (CRC) surveillance completion compared with an electronic control in survivors of childhood cancer at elevated risk for treatment-related CRC, according to results of the randomized ASPIRES trial (NCT05084833) presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.

Among 300 who were randomly assigned, 32% in the patient activation (PA) arm completed CRC screening within 12 months compared with 14% in the control arm, representing a statistically significant threefold improvement in odds (OR, 3.0; 95% CI, 1.5-6.2; P = .003). The PA plus primary care provider (PA + PCP) activation arm achieved a 26% screening completion rate, corresponding to a 2.2-fold odds improvement over control (OR, 2.2; 95% CI, 1.1-4.6; P = .041). Overall, 24% of the 300-patient population completed CRC screening.

Notably, the addition of a structured PCP activation component did not produce meaningfully higher completion rates than patient activation delivered alone. The PA arm's 32% screening rate numerically exceeded the 26% rate seen in the PA + PCP arm, suggesting that the incremental PCP activation layer as designed did not improve adherence beyond what digital patient engagement achieved independently. The PCP component included faxed CRC surveillance recommendations, the patient's treatment summary, an FAQ page, and an insurance letter template to justify early screening.

“An mHealth intervention increased surveillance rates for colorectal [cancer] as a subsequent malignant neoplasm in survivors of childhood cancer,” said presenting study author Tara O. Henderson, MD, MPH, professor of pediatrics in the Section of Hematology/Oncology at the University of Chicago Medicine. “Adding primary care provider activation did not improve adherence to surveillance, and a tailored approach should be used to increase intervention effectiveness.”

Moderator analyses identified education level and presence of chronic conditions as factors influencing intervention effectiveness. Among survivors with a high school education or less, the intervention produced an OR of 4.4 (95% CI, 1.3-20.2; P = .014) vs control, compared with an OR of 2.2 (95% CI, 1.1-4.8; P = .034) among those with at least a college degree. For survivors without any chronic conditions, the intervention produced an OR of 3.6 (95% CI, 1.5-10.1; P = .003), while those with chronic conditions showed an OR of 1.9 (95% CI, 0.8-4.8; P = .2). “It appeared that education level and chronic conditions impact how well the intervention worked,” Henderson noted, though the study was underpowered to formally test these interactions.

ASPIRES enrolled 300 childhood cancer survivors from the Childhood Cancer Survivor Study (CCSS), an NCI-funded North American cohort of more than 23,000 five-year survivors diagnosed between 1970 and 2000 across 31 institutions. Eligibility for enrollment in ASPIRES required an age of at least 30 years, prior abdominal or pelvic radiotherapy of any dose, no personal or family history of CRC, and no colonoscopy in the past 5 years or Cologuard in the past 3 years.

Participants were randomly assigned 1:1:1 to the control, PA, or PA + PCP activation arms, and they were stratified by age at enrollment (30 to 44 vs 45 years or older). The trial used a 3-arm randomized hybrid type II effectiveness and implementation design.

The study achieved 93% completion of the 12-month questionnaire and enrolled a population that was predominantly aged 30 to 44 (68%), 81% were White non-Hispanic, 55% were female, and 95% were insured. Primary cancer diagnoses included Wilms tumor (33%), lymphoma (22%), leukemia (14%), central nervous system tumors (13%), or sarcoma (10%).

The PA intervention delivered tailored text messages, video vignettes, and resource links through the Mosio platform. All 3 arms received electronic resources including a survivorship care plan. The primary outcome was comparing the proportion of patients who underwent colonoscopy or Cologuard, with colonoscopy required if Cologuard was positive, in each intervention arm vs the control arm. Secondary outcomes included baseline characteristics and moderators of CRC surveillance uptake.

The study's design was grounded in the context of persistently low CRC surveillance uptake in this population: adherence to recommended surveillance among eligible childhood cancer survivors stands at only approximately 37%, despite Children's Oncology Group guidelines recommending screening beginning 5 years after radiotherapy or at age 30, whichever occurs later, using multitarget stool DNA testing every 3 years or colonoscopy every 5 years.

Looking ahead, Henderson noted that ongoing analyses include qualitative interviews, mediating factor assessments, PCP survey data, and a consolidated framework for implementation research evaluation of barriers and facilitators to intervention uptake. Cost-effectiveness analyses are also underway. “We are planning follow-up studies, including how bundling cancer surveillance modalities…or how interactive AI and other tools can improve cancer surveillance outcomes,” Henderson said.

References

Henderson TO, Bardwell JK, Moskowitz CS, et al. The ASPIRES study: Promoting colorectal cancer surveillance in childhood cancer survivors — a randomized intervention trial from the Childhood Cancer Survivor Study (CCSS). J Clin Oncol. 2026;44(suppl 16):10004. doi:10.1200/JCO.2026.44.16_suppl.10004