Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Department of Medical Informatics, The University of Oklahoma School of Community Medicine, Oklahoma City, Oklahoma.
Cancer Epidemiol Biomarkers Prev. 2023 May 1;32(5):634-641. doi: 10.1158/1055-9965.EPI-22-0966.
Children with cancer from rural and nonurban areas face unique challenges. Health equity for this population requires attention to geographic disparities in optimal survivorship-focused care.
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 7 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.
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% confidence interval, 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.
Survivors from large towns and those who were adolescents at the time of diagnosis were more likely to receive suboptimal follow-up care compared with survivors from urban areas and those diagnosed younger than thirteen.
Observed geographic disparities in survivorship care will inform interventions to promote equitable care for survivors from nonurban areas.
来自农村和非城市地区的癌症患儿面临着独特的挑战。要实现这一人群的健康公平，就需要关注最佳生存为重点的医疗服务在地理方面的差距。
俄克拉荷马州儿童癌症幸存者队列基于所有在 2005 年 1 月 1 日至 2014 年 9 月 24 日期间向机构癌症登记处报告且诊断时年龄≤18 岁的患者。随访不充分定义为初始诊断后 5 至 7 年无完成的肿瘤相关门诊就诊（随访结束时幸存者年龄为 7 至 25 岁）。主要关注的预测指标是农村性。
449 名合格幸存者中有 94 名（21%）接受了随访不充分。差异显著（P = 0.01），与来自大城镇（n = 28/78）的幸存者相比，分别有 36%（n = 20/95）和 21%（n = 46/276）来自小镇/孤立农村和城市地区的幸存者和 17%（n = 46/276）的幸存者接受了随访不充分。与非青少年相比，诊断时 45%的青少年未在诊所就诊（P < 0.01）。与来自城市地区的幸存者相比，来自大城镇的幸存者随访不充分的调整风险比为 2.2（95%置信区间，1.5，3.2）。73%的幸存者（n = 271/369）有记录的生存护理计划，农村性也有类似的趋势。
与来自城市地区和诊断年龄小于十三岁的幸存者相比，来自大城镇的幸存者和诊断时为青少年的幸存者更有可能接受随访不充分的治疗。
观察到的生存护理方面的地域差距将为促进非城市地区幸存者获得公平护理的干预措施提供信息。
