title: Factors associated with adherence to preventive care practices among hematopoietic cell transplantation survivors.
abstract: Preventive care guidelines are available for hematopoietic cell transplantation (HCT) survivors. We assessed adherence to these guidelines and examined factors associated with lower adherence. A questionnaire was mailed to adult HCT survivors to collect information regarding survivor health, adherence to recommended guidelines, and financial concerns. Multivariate models identified patient and transplant characteristics associated with lower adherence. Of the 3066 survivors at >2 years after HCT, 1549 (51%) responded. The median age of the respondents was 54.5 years, and the median adherence to recommended preventive care based on age- and sex-specific recommendations was 75%. Lower adherence was associated with autologous HCT, concerns about medical costs, non-white race, male sex, lower physical functioning, absence of chronic graft-versus-host disease, longer time since HCT, and poor knowledge of recommended tests. Although 98% of the respondents had medical insurance, 26% expressed concerns about medical costs and reported efforts to limit medical costs. A concern about medical costs was associated with female sex, age <65 years, absence of chronic graft-versus-host disease, and low physical and mental functional status. Future efforts to improve adherence should address concerns about medical costs and lack of knowledge, two major modifiable predictors of lower adherence to preventive care practices in HCT survivors.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. nkher2@fhcrc.org
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Karen L
authors.initials: KL
authors.lastname: Syrjala
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010349:Patient Compliance; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000191:economics; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014182:Transplantation, Autologous; D055815:Young Adult