title: Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors.
abstract: OBJECTIVE
  Surveillance for long-term complications related to previous cancer therapy can help diagnose/manage chronic health conditions in childhood cancer survivors and improve survivor quality of life. However, a challenge to delivering long-term care to childhood cancer survivors is loss to follow-up; many patients discontinue care at specialized survivor care centers. The purpose of this study was to examine patterns of loss to follow-up among a cohort of childhood cancer survivors.
  
  
  METHODS
  This retrospective study examined follow-up patterns among a nonrandom representative sample of 370 childhood cancer survivors among 1116 patients from a single institution. The median age of patients at diagnosis was 10.2 years (range <1-21). Factors potentially related to follow-up were utilized to evaluate patterns of follow-up across 5-year intervals following completion of active therapy. The association between patient characteristics and follow-up was evaluated using univariate and multivariate binomial regression models.
  
  
  RESULTS
  The probability of follow-up 1-5 years post-treatment was 91.2% (89.7%-92.5%) but dropped to 68.5% (66.2%-70.8%) during years 6-10, 47.7% (45.0%-50.3%) during years 11-15, and continued to steadily decrease over time. Overall, white race, diagnoses at younger ages, patients with lymphomas/leukemias, and decade of diagnosis were each associated with somewhat better rates of follow-up.
  
  
  CONCLUSIONS
  These findings highlight the lack of follow-up by adult survivors of childhood cancer with only approximately one-half of patients returning for follow-up 10 years after completion of therapy. Interventions focused on educating both patients and primary care physicians may help to increase long-term follow-up care among this at-risk population.
authors.affiliation: 1 Department of Pediatric Oncology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Denise A
authors.initials: DA
authors.lastname: Rokitka
authors.affiliation: 2 Jacobs School of Medicine and Biomedical Sciences, State University at Buffalo , Buffalo, New York.
authors.forename: Colleen
authors.initials: C
authors.lastname: Curtin
authors.affiliation: 1 Department of Pediatric Oncology, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Heffler
authors.affiliation: 3 Department of Health Behavior, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zevon
authors.affiliation: 4 Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute , Buffalo, New York.
authors.forename: Kris
authors.initials: K
authors.lastname: Attwood
authors.affiliation: 5 Department of Medicine, Roswell Park Cancer Institute , Buffalo, New York.|6 Department of Family Medicine, State University of New York at Buffalo , Buffalo, New York.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Mahoney
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000379:methods*; D000073116:Cancer Survivors / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: follow-up care; late effects; long-term follow-up; loss to follow-up; survival; survivorship