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Predictors of attendance at specialized survivor clinics in a population-based cohort of adult survivors of childhood cancer

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Abstract

Purpose

The purpose of the present study is to determine predictors of attendance at a network of publicly funded specialized survivor clinics by a population-based cohort of adult survivors of childhood cancer.

Methods

We conducted a retrospective study linking data on eligible patients identified in a provincial pediatric cancer registry with health administrative databases to determine attendance at five specialized survivor clinics in the Canadian province of Ontario between 1999 and 2012. Eligible survivors were treated for cancer at ≤18 years between 1986 and 2005, had survived ≥5 years from their most recent pediatric cancer event, and contributed ≥1 year of follow-up after age 18 years. We assessed the impact of cancer type, treatment intensity, cumulative chemotherapy doses, radiation, socioeconomic status, distance to nearest clinic, and care from a primary care physician (PCP) on attendance using recurrent event multivariable regression.

Results

Of 7482 children and adolescents treated for cancer over the study period, 3972 were eligible for study inclusion, of which 3912 successfully linked to administrative health data. After a median of 7.8 years (range 0.2–14.0) of follow-up, 1695/3912 (43.3 %) had attended at least one adult survivor clinic visit. Significantly increased rates of attendance were associated with female gender, higher treatment intensity, radiation, higher alkylating agent exposure, higher socioeconomic status, and an annual exam by a PCP. Distance significantly impacted attendance with survivors living >50 km away less likely to attend than those living within 10 km (relative rate 0.77, p = 0.003).

Conclusion

Despite free access to survivor clinics, the majority of adult survivors of childhood cancer do not attend.

Implications for Cancer Survivors

Alternate models of care need to be developed and assessed, particularly for survivors living far from a specialized clinic and those at lower risk of developing late effects.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Paul C. Nathan, Astrid Guttmann & Mark L. Greenberg

  2. Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada

    Paul C. Nathan

  3. The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Mohammad Agha, Astrid Guttmann & Rinku Sutradhar

  4. Princess Margaret Cancer Center, Toronto, ON, Canada

    David Hodgson

  5. The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada

    Jason D. Pole & Mark L. Greenberg

Authors
  1. Paul C. Nathan
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  2. Mohammad Agha
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  3. Jason D. Pole
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  4. David Hodgson
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  5. Astrid Guttmann
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  6. Rinku Sutradhar
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  7. Mark L. Greenberg
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Corresponding author

Correspondence to Paul C. Nathan.

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Funding

This study was funded by the Canadian Institutes of Health Research (CIHR) and the Pediatric Oncology Group of Ontario through funding provided by the Canadian Cancer Society, Ontario Division. Astrid Guttmann receives salary funding through a CIHR Applied Research Chair in Child Health Services Research. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the MOHLTC is intended or should be inferred.

Conflict of interest

Paul Nathan, Mohammad Agha, Jason Pole, Rinku Sutradhar, Astrid Guttmann, David Hodgson, and Mark Greenberg all declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was obtained from the Research Ethics Boards at all five pediatric cancer centers in the province of Ontario. Since the study involved database/registry research only and no patients were contacted as part of the study procedure, the ethics boards waived the need for informed consent.

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Nathan, P.C., Agha, M., Pole, J.D. et al. Predictors of attendance at specialized survivor clinics in a population-based cohort of adult survivors of childhood cancer. J Cancer Surviv 10, 611–618 (2016). https://doi.org/10.1007/s11764-016-0522-y

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  • DOI: https://doi.org/10.1007/s11764-016-0522-y

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