Long Term Survivor's Clinic, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
J Cancer Surviv. 2019 Aug;13(4):547-557. doi: 10.1007/s11764-019-00774-w. Epub 2019 Jun 27.
Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up.
ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior.
One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values.
This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs.
ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
尽管选择的随访模式可能会影响医疗检测的依从性和健康相关生活质量（QOL），但针对儿童癌症成年幸存者（ASCC）的随访护理模式，目前仅有少数研究进行了比较。本研究对加拿大艾伯塔省的两种随访护理模式，即癌症中心模式和社区模式，进行了比较，以确定哪种模式更能使 ASCC 遵循指南推荐的用于检测晚期效应的医疗筛查测试、QOL、身体症状以及进行年度随访。
通过直接联系或多媒体活动，招募了在社区模式下出院（超过 15 年）且出生年份相近（1973-1993 年）的目前在癌症中心模式下接受随访的 ASCC。病历回顾确定了化疗和放疗暴露情况以及所需的医疗晚期效应筛查测试。ASCC 还完成了评估 QOL、身体症状和随访行为的问卷。
共招募了 156 名幸存者（社区组 n=86；癌症中心组 n=70）。主要分析表明，癌症中心 ASCC 遵循指南推荐的总测试依从百分比（中位数=85.4%）显著高于社区模式（中位数=29.2%，U=3996.50，p<0.0001）。癌症中心 ASCC 的 QOL 无显著差异（M=83.85，SD=20.55 与 M=77.50，SD=23.94；t(154)=1.77，p=0.078），而社区模式 ASCC 报告的身体症状群数量较少，并且更遵守随访行为。
本研究强调了癌症中心模式在遵循基于暴露的医疗晚期效应筛查指南、癌症特异性随访行为以及报告 ASCC 身体症状较少方面的优越性。
对于癌症幸存者而言，在癌症中心模式下接受随访的 ASCC 可能受益于更早的晚期效应检测和早期干预机会。
