Hoppmann Anna L, Dai Chen, Hageman Lindsey, Francisco Liton, Knight Jada, Mast Angela, Whelan Kimberly, Bhatia Smita, Landier Wendy
University of South Carolina School of Medicine, Columbia, SC, USA.
Prisma Health, Columbia, SC, USA.
J Cancer Surviv. 2024 Aug 7. doi: 10.1007/s11764-024-01636-w.
Childhood cancer survivors carry a high burden of late-occurring treatment-related morbidity. Long-term risk-based anticipatory surveillance allows for early detection and management of complications. We sought to examine demographic, clinical, and social characteristics associated with survivorship clinic attendance at the Taking on Life after Cancer (TLC) Clinic at the Children's Hospital of Alabama.
The cohort included 1122 TLC-eligible patients diagnosed with cancer between 2000 and 2016. The outcome of interest was ≥1 TLC visit. Univariable logistic regression modeling assessed cancer type, treatment era, age, sex, race/ethnicity, payer type, rural/urban residency, and distance from clinic. Significant variables (P<0.1) were retained in multivariable modeling.
The median age at diagnosis was 7 years old (0-19); 47% were female, 69% non-Hispanic White, 25% African American; 45% leukemia or lymphoma, 53% solid or CNS tumor, 3% other. We found that among 1122 survivors eligible to attend a survivorship clinic in the Deep South, only 52% attended. Odds of attendance were lower among survivors diagnosed at an older age, those with cancers other than leukemia/lymphoma, those lacking private insurance, and those living farther from the clinic. Race/ethnicity and rurality were not associated with clinic attendance.
Just over half of eligible survivors attended survivorship clinic. Factors associated with non-attendance can be used to guide development of intervention strategies to ensure that childhood cancer survivors receive optimal long-term follow-up care.
Measures of healthcare access (insurance status and distance to care) were identified as potential intervention targets to improve uptake of survivorship care.
儿童癌症幸存者承受着与治疗相关的晚期发病的沉重负担。基于长期风险的前瞻性监测有助于早期发现和处理并发症。我们试图研究与阿拉巴马州儿童医院“癌症后面对生活”（TLC）诊所的幸存者门诊就诊相关的人口统计学、临床和社会特征。
该队列包括2000年至2016年间诊断为癌症且符合TLC条件的1122例患者。感兴趣的结局是至少就诊1次TLC门诊。单变量逻辑回归模型评估癌症类型、治疗时代、年龄、性别、种族/民族、付款人类型、农村/城市居住情况以及与诊所的距离。多变量模型保留显著变量（P<0.1）。
诊断时的中位年龄为7岁（0 - 19岁）；47%为女性，69%为非西班牙裔白人，25%为非裔美国人；45%为白血病或淋巴瘤，53%为实体瘤或中枢神经系统肿瘤，3%为其他。我们发现，在1122名符合条件在南部腹地参加幸存者门诊的幸存者中，只有52%就诊。年龄较大时被诊断出的幸存者、患有白血病/淋巴瘤以外癌症的幸存者、缺乏私人保险的幸存者以及居住距离诊所较远的幸存者就诊几率较低。种族/民族和农村地区与门诊就诊无关。
略超过一半的符合条件的幸存者参加了幸存者门诊。与未就诊相关的因素可用于指导制定干预策略，以确保儿童癌症幸存者获得最佳的长期随访护理。
医疗保健可及性指标（保险状况和就医距离）被确定为改善幸存者护理接受度的潜在干预目标。
