Barriers to Care for Childhood Cancer Survivors at Risk for Late Cardiovascular Disease: A Mixed Methods Approach.

Purpose: Cardiovascular disease (CVD) represents a leading cause of late morbidity and mortality among survivors of childhood cancer. This study aimed to address barriers to longitudinal survivorship-focused care. Methods: A previously validated late cardiovascular risk calculator was implemented based on data elements from Passport for Care in a survivorship cohort in Oklahoma. Survivors at moderate and high risk for late CVD were consented and invited to complete a needs assessment survey with knowledge questions on cardiotoxicity. Thematic analysis of interviews with survivors explored barriers to care. Results: Among survivors with PFC (n=477), 71 and 246 were high and moderate risk, respectively. Of the 317 eligible survivors, 80 were contacted and signed electronic consent. Sixty-four percent of participants completed the survey (n=49; 32 survivors and 17 parents or guardians). Areas of greatest need included improved information delivery and financial concerns. Interviews of survivors (n=9) revealed themes such as distance to the hospital, transportation, financial hardship, lack of information, and transitions to adult care as significant barriers to longitudinal survivorship-focused care. Conclusions: Unaddressed information needs, socioeconomic factors, and geography were significant barriers for survivors. Participants were receptive to telehealth-based interventions.