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Purpose <p>Survivorship care is vital to screen for and manage late effects, yet follow-up remains suboptimal. We examined factors associated with long-term survivor clinic (LTSC) nonattendance, delayed initiation, and disengagement at a large, diverse pediatric cancer center.</p> Methods <p>We analyzed outcomes in 1138 survivorship-eligible childhood cancer survivors diagnosed between 2011 and 2019. Outcomes included (1) LTSC nonattendance (no visit ≥ 2&#xa0;years post-treatment), (2) delayed LTSC visit initiation (first visit &gt; 5&#xa0;years from end of treatment), and (3) LTSC visit disengagement (no follow-up after initial LTSC visit). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each outcome were estimated by multivariable logistic regression.</p> Results <p>The mean age at the end of treatment was 9.3&#xa0;years (standard deviation ± 5.6); 56% were male, 50% Latino, and 42% had leukemia. Twenty-one percent never attended LTSC. Nonattendance was associated with older age (aOR = 1.15; 95% CI, 1.11–1.18), public (aOR = 2.37; 95% CI, 1.65–3.44), or no insurance (aOR = 2.58; 95% CI, 1.20–5.42). Delayed initiation was linked to higher odds of disengagement (aOR = 1.28; 95% CI, 0.85–1.92). Disengagement was higher among older (aOR = 1.09; 95% CI, 1.05–1.12) and publicly insured (aOR = 2.29; 95% CI, 1.55–3.42) survivors.</p> Conclusions <p>Timely and accessible survivorship care is essential to mitigating late effects of cancer treatment. Here, one in five survivors did not receive survivorship care and patients that initiated LTSC early were more likely to remain engaged.</p> <p><b>Implications for Cancer Survivors</b></p> <p>Tailored interventions that support older and under-insured survivors and early referral to LTSC may improve survivor initiation and long-term engagement with survivorship care.</p>

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Predictors of long-term follow-up clinic attendance and continued engagement among survivors of cancer in childhood and adolescence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月15日

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  • Ji Yun Tark,
  • Kayla L. Foster,
  • Shawki L. Qasim,
  • Omar Shakeel,
  • Alicia Howell,
  • Mary C. Shapiro,
  • Abiodun Oluyomi,
  • ZoAnn E. Dreyer,
  • Ashley M. Butler,
  • Austin L. Brown,
  • Maria M. Gramatges

摘要

Purpose

Survivorship care is vital to screen for and manage late effects, yet follow-up remains suboptimal. We examined factors associated with long-term survivor clinic (LTSC) nonattendance, delayed initiation, and disengagement at a large, diverse pediatric cancer center.

Methods

We analyzed outcomes in 1138 survivorship-eligible childhood cancer survivors diagnosed between 2011 and 2019. Outcomes included (1) LTSC nonattendance (no visit ≥ 2 years post-treatment), (2) delayed LTSC visit initiation (first visit > 5 years from end of treatment), and (3) LTSC visit disengagement (no follow-up after initial LTSC visit). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with each outcome were estimated by multivariable logistic regression.

Results

The mean age at the end of treatment was 9.3 years (standard deviation ± 5.6); 56% were male, 50% Latino, and 42% had leukemia. Twenty-one percent never attended LTSC. Nonattendance was associated with older age (aOR = 1.15; 95% CI, 1.11–1.18), public (aOR = 2.37; 95% CI, 1.65–3.44), or no insurance (aOR = 2.58; 95% CI, 1.20–5.42). Delayed initiation was linked to higher odds of disengagement (aOR = 1.28; 95% CI, 0.85–1.92). Disengagement was higher among older (aOR = 1.09; 95% CI, 1.05–1.12) and publicly insured (aOR = 2.29; 95% CI, 1.55–3.42) survivors.

Conclusions

Timely and accessible survivorship care is essential to mitigating late effects of cancer treatment. Here, one in five survivors did not receive survivorship care and patients that initiated LTSC early were more likely to remain engaged.

Implications for Cancer Survivors

Tailored interventions that support older and under-insured survivors and early referral to LTSC may improve survivor initiation and long-term engagement with survivorship care.