Predictors of Suboptimal Follow-up in Pediatric Cancer Survivors

Abstract

Attendance to follow-up care after completion of cancer treatment is an understudied area. We examined demographic, clinical, and socioeconomic predictors of follow-up by pediatric cancer patients at a large center in 442 newly diagnosed patients using multivariable logistic regression analyses. Patients who did not return to clinic for at least 1000 days were considered lost to follow-up. Two hundred forty-two (54.8%) patients were lost. In multivariable analyses, the following variables were independent predictors of being lost to follow-up: treatment with surgery alone (odds ratio [OR]=6.7; 95% confidence interval [CI], 3.1-14.9), older age at diagnosis (reference, 0 to 4; ages, 5 to 9: OR=1.8, 95% CI, 1.1-3; ages, 10 to 14: OR=3.3; CI, 1.8-6.1; and ages, 15 and above: OR=4.8; CI, 2.1-11.7), lack of history of stem cell transplantation (OR=2, 95% CI, 1.04-3.7) and lack of insurance (OR=3.4; CI, 1.2-9.2). Hispanic patients had the best follow-up rates (53.7%) compared to whites and blacks (P=0.03). Attendance to long-term follow-up care is suboptimal in childhood cancer survivors. Predictors that were associated with nonattendance can be used to design targeted interventions to improve follow-up care for survivors of pediatric cancer.

Integration of cancer registry and electronic health record data to construct a childhood cancer survivorship cohort, facilitate risk stratification for late effects, and assess appropriate follow‐up care

“…This would bias our population toward the higher risk strata for late effects and support the argument to re‐engage survivors in their follow‐up care. Furthermore, other single‐institution 25 and regional 46 studies for predictors of follow‐up care reported higher rates of follow‐up for younger patients and leukemia survivors, similar to our cohort, though definitions of appropriate follow‐up were not uniform.…”

“…Long‐term follow‐up care of survivors enhances patient education and early detection of late effects 24 . Predictors of suboptimal follow‐up, such as age, insurance status, and race/ethnicity, help identity at‐risk populations 25 . Studies of adult cancer patients from rural areas reveal significant disparities with regards to overall mortality 26–28 and financial toxicity 29 ; however, there is a paucity of data for survivors of childhood cancer.…”

Childhood cancer survivorship: barriers and preferences

“…22,23 Our study highlights the alarming pattern of declining engagement in follow-up care over time, despite survivors' escalating risk of developing late effects, resulting in a significant gap in care. Additional research is therefore needed to evaluate interventions that promote follow-up adherence, 28 particularly in age cohorts where this disparity is greatest. To achieve this, it is critical to address patient-reported barriers and preferences to ensure older survivors remain engaged in care, and to mitigate poor patient outcomes and the associated healthcare system costs.…”

Project Forward: A Population-Based Cohort Among Young Adult Survivors of Childhood Cancers

“…Disparities in health-care utilization among CCS have been observed by ethnicity, with higher proportions of non-Hispanic Whites (vs Hispanic) reporting receipt of cancer-related follow-up care, an association not explained by health insurance coverage ( 8 ). However, such disparities are not observed uniformly, suggesting variation in study samples, or individual- and/or system-level factors associated with health-care access ( 15‐17 ). Underlying drivers of age- and race- and ethnicity-related disparities in CCS follow-up care need continued investigation, particularly among ethnically diverse and more recently treated cohorts, as prior studies of CCS have primarily included non-Hispanic Whites and CCS diagnosed before 1999 and thus have been treated before numerous advances in treatment and survivorship care practices (eg, the broader use of survivorship care plans and survivorship clinics) and the impact of the Afforda ble Care Act (ACA) ( 18 , 19 ).…”