Factors that contribute to post-treatment follow-up care for survivors of childhood cancer.

Abstract

As children complete cancer treatment and enter survivorship, follow-up care is critical to monitor for and treat relapses, secondary malignancies, and late effects of treatment. Relative contributions of cancer and treatment variables and sociodemographic factors in engagement with follow-up care are not fully understood. This study aimed to identify risk factors for inadequate follow-up care.
The sample included a cohort of 173 children (birth-18 years) diagnosed with cancer in 2004 and treated at a children's hospital. Sociodemographics (gender, patient current age, ethnic minority status, distance from hospital, type of insurance), cancer and treatment variables (patient age at diagnosis, type of cancer, treatment modality, time off treatment, relapse, on clinical trial protocol), and follow-up care through 2009 were gathered via the hospital tumor registry and medical charts.
In simultaneous linear regression analysis (full model: F(12, 160) = 3.49, R2 = 0.21, p = 0.001), having a liquid tumor (p < 0.05), presence of relapse (p = 0.009), and shorter distance from hospital (p = 0.006) predicted total number of follow-up visits between completion of treatment and 5 years post-diagnosis. In simultaneous logistic regression analysis (full model: χ2 (12, N = 173) = 53.27, p < 0.001), being male (p = 0.077), having a brain tumor (p = 0.055), longer time off treatment (p = 0.004), and greater distance from hospital (p = 0.003) decreased the likelihood of completing a follow-up or survivorship visit between completion of treatment and 5 years post-diagnosis. In simultaneous linear regression analysis (full model: F(12, 160) = 4.52, R2 = 0.25, p = 0.001), non-White race (p = 0.001) and having public insurance (p = 0.002) predicted total number of no shows between completion of treatment and 5 years post-diagnosis.
These results extend knowledge of health disparities in pediatric cancer follow-up care suggesting that cancer and treatment-related variables (type of cancer, relapse, number of treatment modalities) and sociodemographic factors (distance from treatment center, non-White race, public insurance) are important predictors of engagement in follow-up care.
Survivors at risk for poor engagement may benefit from targeted interventions designed to increase likelihood of follow-up care.