Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
Division of Behavioral Health, Idaho Department of Health and Welfare, Boise, ID, USA.
J Cancer Surviv. 2019 Feb;13(1):56-65. doi: 10.1007/s11764-018-0727-3. Epub 2018 Dec 17.
Childhood cancer survivors need regular, risk-adapted, long-term survivor care. This retrospective study describes the proportion of survivors seen for an initial survivor clinic visit within a large pediatric oncology program.
Patients diagnosed with non-central nervous system childhood malignancies from 2007 to 2012 were followed from the time of survivor clinic eligibility (2 years following completion of therapy) through their initial survivor clinic visit or end of study. Demographic, cancer-related, and logistical factors related to clinic attendance were examined using Kaplan-Meier curves and Cox proportional regressions.
Eligible survivors were 53.0% male, 51.5% non-Hispanic white, and 30.9% survivors of leukemia. Among the 866 eligible survivors for this study, 610 (70.4%) completed their initial visit. After controlling for sex and time eligible, survivors who received surgery only (aHR 0.04 (0.02, 0.08)) or radiation only (0.24 (0.15, 0.39)) and who had Medicaid (0.77 (0.64, 0.92)) were significantly less likely to have an initial visit as were those of black or other/mixed race and those who lived > 25 mi from the clinic (p < 0.01). Survivors aged 6-11 years or 12-17 years at eligibility were significantly more likely to complete an initial visit as compared to those aged 2-5 years (1.55 (1.24, 1.93) and 1.44 (1.14, 1.83), respectively).
Nearly a third of survivors were not seen in a pediatric survivor clinic despite the importance of survivor care. These results identify populations at risk for not pursuing long-term survivorship care.
Failure to transition to pediatric survivor care may lead to lifelong non-engagement and incorrect perceptions about future health.
儿童癌症幸存者需要定期、适应风险的长期生存者护理。本回顾性研究描述了在大型儿科肿瘤项目中，有多少幸存者接受了初始生存者诊所就诊。
从 2007 年至 2012 年，患有非中枢神经系统儿童恶性肿瘤的患者从符合生存者诊所条件（完成治疗后 2 年）开始，到进行初始生存者诊所就诊或研究结束，进行了生存者随访。使用 Kaplan-Meier 曲线和 Cox 比例风险回归，检查与就诊相关的人口统计学、癌症相关和后勤因素。
符合条件的幸存者中，53.0%为男性，51.5%为非西班牙裔白人，30.9%为白血病幸存者。在这项研究的 866 名合格幸存者中，有 610 名（70.4%）完成了首次就诊。在控制了性别和时间因素后，仅接受手术（aHR 0.04（0.02，0.08））或仅接受放疗（0.24（0.15，0.39））以及接受医疗补助（0.77（0.64，0.92））的幸存者以及黑人或其他/混合种族的幸存者以及居住在距离诊所 >25 英里的幸存者（p<0.01），其首次就诊的可能性明显降低。在符合条件时年龄为 6-11 岁或 12-17 岁的幸存者与年龄为 2-5 岁的幸存者相比，更有可能完成首次就诊（分别为 1.55（1.24，1.93）和 1.44（1.14，1.83））。
尽管生存者护理很重要，但仍有近三分之一的生存者未在儿科生存者诊所就诊。这些结果确定了未接受长期生存者护理的高危人群。
未能过渡到儿科生存者护理可能导致终身不参与和对未来健康的错误认知。
