Rural, Large Town, and Urban Differences in Optimal Subspecialty Follow-up and Survivorship Care Plan Documentation among Childhood Cancer Survivors

Abstract

Background: Children with cancer from rural and non-urban areas face unique challenges. Health equity for this population requires attention to geographic disparities in optimal survivorship-focused care. Methods: The Oklahoma Childhood Cancer Survivor Cohort was based on all patients reported to the institutional cancer registry and <18-years-old at diagnosis between January 1, 2005, and September 24, 2014. Suboptimal follow-up was defined as no completed oncology-related clinic visit five to seven years after their initial diagnosis (survivors were 7-25 years old at end of the follow-up period). The primary predictor of interest was rurality. Results: Ninety-four (21%) of the 449 eligible survivors received suboptimal follow-up. There were significant differences (p=0.01) as 36% of survivors from large towns (n=28/78) compared with 21% (n=20/95) and 17% (n=46/276) of survivors from small town/isolated rural and urban areas received suboptimal follow-up, respectively. Forty-five percent of adolescents at diagnosis were not seen in the clinic compared with 17% of non-adolescents (p<0.01). An adjusted risk ratio of 2.2 (95% CI 1.5, 3.2) was observed for suboptimal follow-up among survivors from large towns, compared with survivors from urban areas. Seventy-three percent of survivors (n=271/369) had a documented survivorship care plan with similar trends by rurality. Conclusions: Survivors from large towns and those who were adolescents at the time of diagnosis were more likely to receive suboptimal follow-up care compared to survivors from urban areas and those diagnosed younger than thirteen. Impact: Observed geographic disparities in survivorship care will inform interventions to promote equitable care for survivors from non-urban areas.

Primary Care Utilization and Cardiovascular Screening in Adult Survivors of Childhood Cancer

“…37 Thus, analysis of this relatively privileged group potentially overestimates adherence among all long-term survivors of childhood cancer, given reported disparities in accessing various aspects of survivorship care. 38 , 39 , 40 If so, these findings demonstrate an even greater need for solutions to optimize cardiovascular screening for all adult survivors of childhood cancer.…”

“…Our study cohort also comprises a large number of participants who identified as non-Hispanic White and were more likely to have health insurance than the general US population, among whom the proportions of uninsured adults aged 19 to 64 years ranges from 9% to 15% . Thus, analysis of this relatively privileged group potentially overestimates adherence among all long-term survivors of childhood cancer, given reported disparities in accessing various aspects of survivorship care . If so, these findings demonstrate an even greater need for solutions to optimize cardiovascular screening for all adult survivors of childhood cancer.…”

Informatics tools to implement late cardiovascular risk prediction modeling for population management of high‐risk childhood cancer survivors

“…Seventy‐three percent of all survivors in remission in the Oklahoma cohort have a record in PFC. Of note, survivors without PFC were significantly more likely to be older, live in a nonurban area, and live further away from the medical center compared with survivors with PFC 33 . For population‐level treatment exposures, we downloaded data from the encrypted PFC service to a secure shared folder behind the University of Oklahoma Health Sciences firewall, accessible with log‐in only by key study personnel approved by the Institutional Review Board as part of the data and safety monitoring plan.…”

“…Of note, survivors without PFC were significantly more likely to be older, live in a nonurban area, and live further away from the medical center compared with survivors with PFC. 33…”

Rurality, Cardiovascular Risk Factors, and Early Cardiovascular Disease among Childhood, Adolescent, and Young Adult Cancer Survivors

“…13 Previously identi ed disparities among adolescents and survivors from non-urban areas in survivorship care, such as optimal subspecialty follow-up and receipt of a survivorship care plan, may also in uence downstream treatment-related CVD. 14 This is particularly important for vulnerable populations, such as those from rural areas, are already at increased risk for CVRFS and CVD later in life. [15][16][17] Moreover, fragmented healthcare systems for AYA survivors and those from non-urban areas underscore the role of data standards to surmount siloed data challenges through interoperability with the ultimate goal to improve patient care.…”