title: Predictors of attendance at specialized survivor clinics in a population-based cohort of adult survivors of childhood cancer.
abstract: The purpose of the present study is to determine predictors of attendance at a network of publicly funded specialized survivor clinics by a population-based cohort of adult survivors of childhood cancer.
  
  
  
  We conducted a retrospective study linking data on eligible patients identified in a provincial pediatric cancer registry with health administrative databases to determine attendance at five specialized survivor clinics in the Canadian province of Ontario between 1999 and 2012. Eligible survivors were treated for cancer at ≤18 years between 1986 and 2005, had survived ≥5 years from their most recent pediatric cancer event, and contributed ≥1 year of follow-up after age 18 years. We assessed the impact of cancer type, treatment intensity, cumulative chemotherapy doses, radiation, socioeconomic status, distance to nearest clinic, and care from a primary care physician (PCP) on attendance using recurrent event multivariable regression.
  
  
  
  Of 7482 children and adolescents treated for cancer over the study period, 3972 were eligible for study inclusion, of which 3912 successfully linked to administrative health data. After a median of 7.8 years (range 0.2-14.0) of follow-up, 1695/3912 (43.3 %) had attended at least one adult survivor clinic visit. Significantly increased rates of attendance were associated with female gender, higher treatment intensity, radiation, higher alkylating agent exposure, higher socioeconomic status, and an annual exam by a PCP. Distance significantly impacted attendance with survivors living >50 km away less likely to attend than those living within 10 km (relative rate 0.77, p = 0.003).
  
  
  
  Despite free access to survivor clinics, the majority of adult survivors of childhood cancer do not attend.
  
  
  
  Alternate models of care need to be developed and assessed, particularly for survivors living far from a specialized clinic and those at lower risk of developing late effects.
authors: Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada. paul.nathan@sickkids.ca.|Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. paul.nathan@sickkids.ca.
authors: Paul C
authors: PC
authors: Nathan
authors: The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors: Mohammad
authors: M
authors: Agha
authors: The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.
authors: Jason D
authors: JD
authors: Pole
authors: Princess Margaret Cancer Center, Toronto, ON, Canada.
authors: David
authors: D
authors: Hodgson
authors: Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.|The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors: Astrid
authors: A
authors: Guttmann
authors: The Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors: Rinku
authors: R
authors: Sutradhar
authors: Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.|The Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.
authors: Mark L
authors: ML
authors: Greenberg
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D012042:Registries; D017741:Survivors
keywords: Administrative health databases; Cancer registries; Childhood cancer survivors; Models of care; Survivor clinics