title: Patterns and predictors of survivorship clinic attendance in a population-based sample of pediatric and young adult childhood cancer survivors.
abstract: Because many survivors do not receive recommended follow-up, we sought to characterize patterns and predictors of survivorship clinic attendance in a population-based sample of childhood cancer survivors.
  
  
  
  Using the Connecticut Tumor Registry, we identified all patients diagnosed with cancer at age ≤ 18 years from March 1, 1998 to March 1, 2008, still in follow-up 5 years post-diagnosis, and living <100 miles from Yale. Survivorship clinic attendance, demographics, disease characteristics, and treatment exposures were ascertained. Vital status was confirmed with the National Death Index. The Kaplan-Meier curves and hazard ratios were calculated for survivorship clinic attendance.
  
  
  
  Four hundred eighty-nine eligible survivors currently 19.1 ± 6.2 years old were diagnosed at a mean age of 9.1 ± 5.8 years with leukemias/lymphomas (47.2 %), central nervous system tumors (16.4 %), sarcomas (11.2 %), thyroid cancers or melanomas (7.8 %), and other solid tumors (17.4 %). The 10-year post-diagnosis clinic attendance probability was 27.8 % (SE = 2.3) overall, and 36.9 % (SE = 4.4) and 40.8 % (SE = 3.8), in patients with radiation and anthracycline exposure, respectively. In adjusted analysis, patients with insurance (HR = 2.90; p < 0.01 for private and HR = 2.05; p = 0.02 for public assistance), treated with anthracyclines (HR = 3.05; p < 0.01), and treated with radiation (HR = 1.90; p < 0.01) were significantly more likely to attend clinic.
  
  
  
  The majority of childhood cancer survivors in our population-based sample had not attended survivorship clinic, even among those with high-risk exposures. Health care access, as measured by insurance status, was an important predictor of clinic attendance.
  
  
  
  More research is needed to clarify the link between insurance status and survivorship care to increase appropriate late effects surveillance in this population.
authors.affiliation: Yale University School of Medicine Section of Pediatric Hematology and Oncology, 333 Cedar Street, LMP 2073, New Haven, CT, 06510, USA. daniel.zheng@yale.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Zheng
authors.affiliation: Yale University School of Public Health Department of Biostatistics, New Haven, CT, USA.
authors.forename: Kyaw
authors.initials: K
authors.lastname: Sint
authors.affiliation: Yale University School of Medicine Section of Pediatric Hematology and Oncology, 333 Cedar Street, LMP 2073, New Haven, CT, 06510, USA.
authors.forename: Hannah-Rose
authors.initials: HR
authors.lastname: Mitchell
authors.affiliation: Yale University School of Medicine Section of Pediatric Hematology and Oncology, 333 Cedar Street, LMP 2073, New Haven, CT, 06510, USA.|Yale Cancer Center, New Haven, CT, USA.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000293:Adolescent; D000328:Adult; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008134:Long-Term Care; D008297:Male; D009369:Neoplasms / Q000191:economics / Q000453:epidemiology / Q000534:rehabilitation*; D010358:Patient Participation / Q000191:economics / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Childhood cancer survivorship; Health services; Healthcare access; Long-term follow-up care; Surveillance