title: Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer.
abstract: 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.
authors.affiliation: Division of Behavioral Medicine, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA. james.klosky@stjude.org
authors.forename: James L
authors.initials: JL
authors.lastname: Klosky
authors.forename: Darlene K
authors.initials: DK
authors.lastname: Cash
authors.forename: Joanna
authors.initials: J
authors.lastname: Buscemi
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Danette M
authors.initials: DM
authors.lastname: Garces-Webb
authors.forename: Wenyan
authors.initials: W
authors.lastname: Zhao
authors.forename: Sally
authors.initials: S
authors.lastname: Wiard
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: 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
references.citation: J Pediatr Psychol. 2000 Oct-Nov;25(7):493-502
references.pmid: 11007806
references.citation: Lancet Oncol. 2006 Jun;7(6):489-98
references.pmid: 16750499
references.citation: CA Cancer J Clin. 2004 Jul-Aug;54(4):208-36
references.pmid: 15253918
references.citation: J Clin Oncol. 2004 Dec 15;22(24):4979-90
references.pmid: 15576413
references.citation: N Engl J Med. 2006 Oct 12;355(15):1572-82
references.pmid: 17035650
references.citation: Cancer Causes Control. 2005 Oct;16 Suppl 1:51-9
references.pmid: 16208574
references.citation: J Clin Oncol. 2001 Jul 1;19(13):3163-72
references.pmid: 11432882
references.citation: Ann Fam Med. 2004 Jan-Feb;2(1):61-70
references.pmid: 15053285
references.citation: J Pediatr Oncol Nurs. 2004 May-Jun;21(3):170-4
references.pmid: 15296048
references.citation: Cancer. 1993 May 15;71(10 Suppl):3406-10
references.pmid: 8490890
references.citation: Pediatr Blood Cancer. 2006 Feb;46(2):135-42
references.pmid: 16369921
references.citation: Cancer. 2006 Aug 15;107(4):841-8
references.pmid: 16886175
references.citation: J Clin Oncol. 2006 Nov 10;24(32):5117-24
references.pmid: 17093273
references.citation: Arch Dis Child. 2004 Apr;89(4):374-7
references.pmid: 15033851
references.citation: BMJ. 2001 Aug 4;323(7307):271-4
references.pmid: 11485960
references.citation: Hematol Oncol Clin North Am. 2008 Apr;22(2):211-31, v-vi
references.pmid: 18395146