Clinical and social determinants of survivorship clinic attendance in head and neck cancer.

PURPOSE

Despite its importance, little is known about the patterns and predictors of Survivorship Clinic attendance in head and neck cancer (HNC). We sought to determine the cumulative incidence of Survivorship Clinic attendance stratified by demographic, clinical, and socioeconomic factors, and to identify factors independently associated with attendance.

METHODS

Our analysis population consisted of 2,252 patients diagnosed with primary HNC and seen at our institution's HNC Survivorship Clinic after completing treatment from 2016-2021. Factors associated with increased likelihood of attending the Survivorship Clinic post-treatment, within five years of diagnosis, were identified using Cox proportional hazards regression.

RESULTS

The overall cumulative incidence of Survivorship Clinic attendance reached 47.5% (95% confidence interval [CI]: 44.3-50.5%). Greater distance from clinic ((30-60 miles] hazard ratio [HR]: 0.58, 95% CI: 0.44-0.76, and > 60 miles HR: 0.46, 95% CI: 0.34-0.62) was independently associated with decreased likelihood of attendance. Factors independently associated with increased likelihood of attendance were stage III (HR: 1.47, 95% CI: 1.11-1.95) or IV (HR: 1.54, 95% CI: 1.15-2.05) cancer and treatment with radiotherapy (HR: 2.78, 95% CI: 2.12-3.64).

CONCLUSIONS

Less than half of our cohort attended the Survivorship Clinic post-treatment, within the first five years of diagnosis. Clinical factors, including disease stage and treatment modality, and social determinants, including distance from the clinic, were independently associated with Survivorship Clinic attendance.

IMPLICATIONS FOR CANCER SURVIVORS

These findings underscore the need for targeted interventions to increase access to survivorship care in HNC.