Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the demographic, medical, and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer.
Adherence to clinic attendance was monitored among 941 long-term childhood cancer survivors scheduled for evaluation. Patients were classified as “attenders” or “non-attenders” based on the outcome of their first scheduled clinic appointment over a one year period. Social work staff contacted non-attenders by telephone to determine reasons for missed appointments.
Nearly 15% of survivors were classified as non-attenders. Univariate findings revealed that older age, lower SES, being non-white, less medically insured, traveling by car, living shorter distance from clinic, having a scheduled social work consultation, and entering or exiting survivorship clinic were associated with clinic non-attendance (all p values < 0.05). The final multivariate model indicated that non-whites (OR = 1.88, 95% CI = 1.19–2.97), patients without insurance (OR = 2.36, 95% CI = 1.98–3.79), those traveling by car (OR = 12.74, 95% CI = 3.97–40.86), and those who have not experienced secondary cancer events (OR = 1.76, 95% CI = 0.94–3.28) were more likely to be non-attenders. Work or school conflicts were the primary reasons cited for missed appointments.
Despite mechanisms designed to reduce financial burdens associated with attending survivorship clinic at our institution, demographic, medical, and logistic barriers exist which impact participation in long-term follow-up.
Implications for cancer survivors and providers
These results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic non-attendance, particularly among underserved populations.
- Ries LAG, Eisner MP, Kosary CL, et al. Cancer statistics review, 1973–1999. Bethesda, MD: National Cancer Institute; 2002.
- Mertens AC, Yasui Y, Neglia JP, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the childhood cancer survivor study. J Clin Oncol. 2001;19:3163–72.
- Oeffinger KC, Hudson MM. Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors. CA Cancer J Clin 2004;54(4):208–36. CrossRef
- Oeffinger KC, Mertens AC, Sklar CA. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572–82. doi:10.1056/NEJMsa060185. CrossRef
- Landier W, Bhatia S, Eshelman DA, et al. Development of risk-based guidelines for pediatric cancer survivors: the Children’s Oncology Group Long-Term Follow-Up Guidelines from the Children’s Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol. 2004;22(24):4979–90. doi:10.1200/JCO.2004.11.032. CrossRef
- Johnson R, Horne B, Feltbower RG, Butler GE, Glaser AW. Hospital attendance patterns in long term survivors of cancer. Arch Dis Child. 2004;89:374–77. doi:10.1136/adc.2002.021816. CrossRef
- Skinner R, Wallace WHB, Levitt GA. Long term follow-up of people who have survived cancer during childhood. Lancet Oncol. 2006;7:489–98. doi:10.1016/S1470–2045(06)70724–0. CrossRef
- Keene N, Hobbie W, Runcione K. Childhood cancer survivors: a practical guide to your future. Sebastopol, CA: O’Reilly; 2000.
- Wallace WHB, Blacklay A, Eiser C, et al. Developing strategies for long-term follow-up of survivors of childhood cancer. BMJ (Clinical Research Ed.). 2001;323:271–74. doi:10.1136/bmj.323.7307.271. CrossRef
- Verrill JR, Schafer J, Vannatta K, et al. Aggression, anti-social behavior, and substance abuse in survivors of pediatric cancer: Possible protective effects if cancer and its treatment. J Pediatr Psychol. 2000;25:493–502.
- Robison LL. Issues in the consideration of intervention strategies in long-term survivors of childhood cancer. Cancer 1993;71:3406–10. doi:10.1002/1097-0142(19930515)71:10+<3406::AID-CNCR2820711745>3.0.CO;2-3. CrossRef
- Pollack LA, Greer GE, Rowland JH, et al. Cancer survivorship: a new challenge in comprehensive cancer control. Cancer Causes & Control 2005;16:51–9. doi:10.1007/s10552-005-0452-x. CrossRef
- Oeffinger KC, Wallace H. Barriers to follow-up of survivors in the United States and the United Kingdom. Pediatric Blood & Cancer 2006;46:135–42. doi:10.1002/pbc.20614. CrossRef
- Children’s Oncology Group.Version 2.0 of the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links 2006; www.survivorshipguidelines.org.
- Aziz NM, Oeffinger KC, Brooks S, Turoff AJ. Comprehensive long-term follow-up programs for pediatric cancer survivors. Cancer 2006;107:841–48. doi:10.1002/cncr.22096. CrossRef
- Hudson MM, Hester A, Sweeney T, et al. A model of care for childhood cancer survivors that facilitates research. J Pediatr Oncol Nurs. 2004;21:1–5. doi:10.1177/1043454204264388. CrossRef
- Hudson MM. Survivors of childhood cancer: Coming of age. Hematol/Oncol Clin North Am. 2008;22:211–31. doi:10.1016/j.hoc.2008.01.011. CrossRef
- Oeffinger KC, McCabe MS. Models for delivering survivorship care. J Clin Oncol. 2006;24:5117–24. doi:10.1200/JCO.2006.07.0474. CrossRef
- Oeffinger KC, Mertens AC, Hudson MM, et al. Health care of young adult survivors of childhood cancer: A report from the childhood cancer survivor study. Annals of Family Medicine 2004;2:61–70. doi:10.1370/afm.26. CrossRef
- Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer
Journal of Cancer Survivorship
Volume 2, Issue 4 , pp 225-232
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Clinic attendance
- Adolescent/Young Adult
- Childhood cancer
- Industry Sectors
- Author Affiliations
- 1. Division of Behavioral Medicine, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN, 38105-2794, USA
- 2. Department of Oncology, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN, 38105-2794, USA
- 4. Department of Psychology, University of Memphis, 202 Psychology Bldg., Memphis, TN, 38152-6400, USA
- 3. Department of Biostatistics, St. Jude Children’s Research Hospital, 332 N. Lauderdale, Memphis, TN, 38105-2794, USA
- 5. Department of Pediatrics, University of Tennessee Health Science Center, 777 Washington Ave. Suite P110, Memphis, TN, 38105, USA