Patient Characteristics and Neighborhood-Level Social Determinants of Health Associated With Childhood Cancer Survivor Follow-Up at Urban Cancer Centers.

backgroundMany childhood cancer survivors (CCS) do not receive long-term follow-up care. We investigated the association of patient characteristics and neighborhood-level social determinants of health (SDOH) with follow-up.

methodsCCS (N = 354) diagnosed 2013-2022 at age <18 years were identified from cancer registries at two urban hospitals. Demographics and cancer history were abstracted from the cancer registries, supplemented by electronic health record data. Vital status was ascertained from the National Death Index. Neighborhood-level SDOH was measured with social vulnerability index, childhood opportunity index, and area deprivation index. Outcomes included survivorship clinic attendance ≥ 2 years posttherapy and any ambulatory visit ≥3 and ≥5 years posttherapy at the hospitals.

resultsSurvivorship clinic attendance was 52% ≥2 years posttherapy. Nonattendance was associated with adolescent age at diagnosis (42% for 11-17 vs. 65% for 6-10 years; p = 0.012), non-Hispanic Black race and ethnicity versus non-Hispanic White (32 vs. 57%, p = 0.048), and central nervous system (CNS) versus hematologic cancer (19 vs. 54%, p = 0.0005). The frequency of any ambulatory visit declined from 60% ≥3 years posttherapy to 40% ≥5 years posttherapy. Although 60% of CNS cancer survivors remained in ambulatory follow-up ≥5 years posttherapy, only 19% attended survivorship clinic. In multivariate analyses, neighborhood-level SDOH measures were not associated with follow-up.

conclusionsThere was a substantial drop in follow-up among CCS from 3 to 5 years posttherapy. Future studies of follow-up should focus on engagement of CNS cancer survivors, patients diagnosed during adolescence, and minority groups.