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Patterns and predictors of survivorship clinic attendance in a population-based sample of pediatric and young adult childhood cancer survivors

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Abstract

Purpose

Because many survivors do not receive recommended follow-up, we sought to characterize patterns and predictors of survivorship clinic attendance in a population-based sample of childhood cancer survivors.

Methods

Using the Connecticut Tumor Registry, we identified all patients diagnosed with cancer at age ≤ 18 years from March 1, 1998 to March 1, 2008, still in follow-up 5 years post-diagnosis, and living <100 miles from Yale. Survivorship clinic attendance, demographics, disease characteristics, and treatment exposures were ascertained. Vital status was confirmed with the National Death Index. The Kaplan-Meier curves and hazard ratios were calculated for survivorship clinic attendance.

Results

Four hundred eighty-nine eligible survivors currently 19.1 ± 6.2 years old were diagnosed at a mean age of 9.1 ± 5.8 years with leukemias/lymphomas (47.2 %), central nervous system tumors (16.4 %), sarcomas (11.2 %), thyroid cancers or melanomas (7.8 %), and other solid tumors (17.4 %). The 10-year post-diagnosis clinic attendance probability was 27.8 % (SE = 2.3) overall, and 36.9 % (SE = 4.4) and 40.8 % (SE = 3.8), in patients with radiation and anthracycline exposure, respectively. In adjusted analysis, patients with insurance (HR = 2.90; p < 0.01 for private and HR = 2.05; p = 0.02 for public assistance), treated with anthracyclines (HR = 3.05; p < 0.01), and treated with radiation (HR = 1.90; p < 0.01) were significantly more likely to attend clinic.

Conclusions

The majority of childhood cancer survivors in our population-based sample had not attended survivorship clinic, even among those with high-risk exposures. Health care access, as measured by insurance status, was an important predictor of clinic attendance.

Implications for Cancer Survivors

More research is needed to clarify the link between insurance status and survivorship care to increase appropriate late effects surveillance in this population.

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Acknowledgments

This publication was made possible by the Yale University School of Medicine Medical Student Research Fellowship at Yale University School of Medicine. NKL was supported by American Cancer Society RSGHP-10-107-01-CPHPS, Research Scholar Grant in Cancer Control.

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Authors and Affiliations

  1. Yale University School of Medicine Section of Pediatric Hematology and Oncology, 333 Cedar Street, LMP 2073, New Haven, CT, 06510, USA

    Daniel J. Zheng, Hannah-Rose Mitchell & Nina S. Kadan-Lottick

  2. Yale University School of Public Health Department of Biostatistics, New Haven, CT, USA

    Kyaw Sint

  3. Yale Cancer Center, New Haven, CT, USA

    Nina S. Kadan-Lottick

Authors
  1. Daniel J. Zheng
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  2. Kyaw Sint
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  4. Nina S. Kadan-Lottick
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Corresponding author

Correspondence to Daniel J. Zheng.

Ethics declarations

We have no conflicts of interest to disclose. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Ethical approval

The Yale University Human Investigation Committee approved the current study.

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Zheng, D.J., Sint, K., Mitchell, HR. et al. Patterns and predictors of survivorship clinic attendance in a population-based sample of pediatric and young adult childhood cancer survivors. J Cancer Surviv 10, 505–513 (2016). https://doi.org/10.1007/s11764-015-0493-4

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  • DOI: https://doi.org/10.1007/s11764-015-0493-4

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