Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer.
BACKGROUND
Attendance at long-term follow-up clinic is necessary for survivors of childhood cancer to facilitate education about cancer-related health risks, early detection of treatment-related morbidity, and implementation of health-promoting interventions. Despite the need for continued care, barriers to clinic attendance exist. The purpose of this prospective study was to identify the demographic, medical, and logistic factors impacting clinic attendance and long-term follow-up care among survivors of childhood cancer.


METHODS
Adherence to clinic attendance was monitored among 941 long-term childhood cancer survivors scheduled for evaluation. Patients were classified as "attenders" or "non-attenders" based on the outcome of their first scheduled clinic appointment over a one year period. Social work staff contacted non-attenders by telephone to determine reasons for missed appointments.


RESULTS
Nearly 15% of survivors were classified as non-attenders. Univariate findings revealed that older age, lower SES, being non-white, less medically insured, traveling by car, living shorter distance from clinic, having a scheduled social work consultation, and entering or exiting survivorship clinic were associated with clinic non-attendance (all p values < 0.05). The final multivariate model indicated that non-whites (OR = 1.88, 95% CI = 1.19-2.97), patients without insurance (OR = 2.36, 95% CI = 1.98-3.79), those traveling by car (OR = 12.74, 95% CI = 3.97-40.86), and those who have not experienced secondary cancer events (OR = 1.76, 95% CI = 0.94-3.28) were more likely to be non-attenders. Work or school conflicts were the primary reasons cited for missed appointments.


CONCLUSIONS
Despite mechanisms designed to reduce financial burdens associated with attending survivorship clinic at our institution, demographic, medical, and logistic barriers exist which impact participation in long-term follow-up. IMPLICATIONS FOR CANCER SURVIVORS AND PROVIDERS: These results highlight the importance of developing tailored outreach strategies for survivors of childhood cancer at-risk for clinic non-attendance, particularly among underserved populations.
Klosky
James L
JL
Division of Behavioral Medicine, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA. james.klosky@stjude.org
Cash
Darlene K
DK
Buscemi
Joanna
J
Lensing
Shelly
S
Garces-Webb
Danette M
DM
Zhao
Wenyan
W
Wiard
Sally
S
Hudson
Melissa M
MM
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001294:Attitude to Health; D002648:Child; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
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