An investigation of survivorship clinic attendance among childhood cancer survivors living in a five-state rural region

Abstract

Purpose: Cancer survivorship clinics manage cancer-related health complications and are available primarily in urban areas. We examine how demographic, clinical, and geographic-based characteristics are associated with attendance at the only pediatric survivorship clinic in a largely rural, multistate region. Methods: One thousand eight hundred sixteen cancer survivors were diagnosed at age ≤ 25 from 1986 to 2005 while living in the region. Cox models incorporating death as a competing risk and generalized estimating equations calculated hazards ratios (HR) for characteristics measured at the clinic’s opening. Subjects were followed from the clinic opening their first visit, death, emigration from the catchment area, or December 31, 2014. Results: Five percent of survivors visited the clinic. Attendance is positively associated with a leukemia or lymphoma diagnosis (HR = 3.32, 95% confidence interval [CI] = 1.72–6.78 vs CNS tumors), previous relapse (HR = 1.78, 95% CI = 1.00–3.19), and residing >100 mi from the clinic (HR = 2.05, 95% CI 1.03–4.10). Survivors aged ≥ 31 years at clinic opening (HR = 0.19, 95% CI = 0.07–0.54) are less likely to attend than younger survivors. Residence between 16 and 100 mi had an inverse association with attendance, although not significant. Conclusion: Survivorship clinics are not widely attended by survivors in this catchment region. Efforts should be made to recruit survivors aged ≥ 31 and diagnosed with CNS tumors. Distance has a complex association with attendance, which could be attributed to the limited availability of preventative services in regions > 100 mi from the clinic. Implications for Cancer Survivors: Survivors living in this catchment region may not be receiving care necessary to prevent severe late effects.