title: Factors that contribute to post-treatment follow-up care for survivors of childhood cancer.
abstract: BACKGROUND
  As children complete cancer treatment and enter survivorship, follow-up care is critical to monitor for and treat relapses, secondary malignancies, and late effects of treatment. Relative contributions of cancer and treatment variables and sociodemographic factors in engagement with follow-up care are not fully understood. This study aimed to identify risk factors for inadequate follow-up care.
  
  
  METHODS
  The sample included a cohort of 173 children (birth-18 years) diagnosed with cancer in 2004 and treated at a children's hospital. Sociodemographics (gender, patient current age, ethnic minority status, distance from hospital, type of insurance), cancer and treatment variables (patient age at diagnosis, type of cancer, treatment modality, time off treatment, relapse, on clinical trial protocol), and follow-up care through 2009 were gathered via the hospital tumor registry and medical charts.
  
  
  RESULTS
  In simultaneous linear regression analysis (full model: F(12, 160) = 3.49, R2 = 0.21, p = 0.001), having a liquid tumor (p < 0.05), presence of relapse (p = 0.009), and shorter distance from hospital (p = 0.006) predicted total number of follow-up visits between completion of treatment and 5 years post-diagnosis. In simultaneous logistic regression analysis (full model: χ2 (12, N = 173) = 53.27, p < 0.001), being male (p = 0.077), having a brain tumor (p = 0.055), longer time off treatment (p = 0.004), and greater distance from hospital (p = 0.003) decreased the likelihood of completing a follow-up or survivorship visit between completion of treatment and 5 years post-diagnosis. In simultaneous linear regression analysis (full model: F(12, 160) = 4.52, R2 = 0.25, p = 0.001), non-White race (p = 0.001) and having public insurance (p = 0.002) predicted total number of no shows between completion of treatment and 5 years post-diagnosis.
  
  
  CONCLUSIONS
  These results extend knowledge of health disparities in pediatric cancer follow-up care suggesting that cancer and treatment-related variables (type of cancer, relapse, number of treatment modalities) and sociodemographic factors (distance from treatment center, non-White race, public insurance) are important predictors of engagement in follow-up care.
  
  
  CONCLUSIONS
  Survivors at risk for poor engagement may benefit from targeted interventions designed to increase likelihood of follow-up care.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd., 10303 CTRB, Philadelphia, PA 19104, USA. barakat@email.chop.edu
authors.forename: Lamia P
authors.initials: LP
authors.lastname: Barakat
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Schwartz
authors.forename: Margo M
authors.initials: MM
authors.lastname: Szabo
authors.forename: Heather M
authors.initials: HM
authors.lastname: Hussey
authors.forename: Greta R
authors.initials: GR
authors.lastname: Bunin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult