Affiliation:
1. Université de Paris ECEVE UMR 1123 INSERM (National Institute for Health and Medical Research) Paris France
2. Pediatric Department AP‐HP Antoine Béclère Hospital Université Paris‐Saclay Clamart France
3. INSERM Radiation Epidemiology Team Villejuif France
4. Department of Clinical Research Gustave Roussy Villejuif France
5. Université Paris‐Saclay Université Paris‐Sud UVSQ CESP Villejuif France
6. Department of Children and Adolescent Oncology Gustave Roussy Université Paris‐Saclay Villejuif France
7. LabUrba Université Paris Est Créteil (UPEC) Créteil France
8. Institut Universitaire de France (IUF) Paris France
Abstract
AbstractBackgroundLong‐term follow‐up (LTFU) clinics have been developed but only some childhood cancer survivors (CCS) attend long‐term follow‐up (LTFU).ObjectiveTo identify factors that influence LTFU attendance.MethodsFive‐year CCS treated for a solid tumor or lymphoma in Gustave Roussy before 2000, included in the FCCSS cohort (French Childhood Cancer Survivor Study), aged >18 years and alive at the date of the LTFU Clinic opening (January 2012) were invited to a LTFU visit. Factors associated with attendance at the LTFU clinic between 2012 and 2020 were estimated using logistic regression analyses. Analyses included different types of factors: clinical (tumor characteristics, cancer treatments, late effects), medical (medical expenses were used as a proxy of survivor’s health status), social (deprivation index based on census‐tract data relating to income, educational level, proportion of blue‐collar workers, and unemployed people living in the area of residence), and spatial (distance to the LTFU clinic).ResultsAmong 2341 CCS contacted (55% males, mean age at study, 45 years; SD ± 10 years; mean age at diagnosis, 6 years; SD ± 5 years), 779 (33%) attended at least one LTFU visit. Initial cancer‐related factors associated with LTFU visit attendance were: treatment with both radiotherapy and chemotherapy (odds ratio [OR], 4.02; 95% CI, 2.11–7.70), bone sarcoma (OR, 2.43; 95% CI, 1.56–3.78), central nervous system primitive tumor (OR, 1.65; 95% CI, 1.02–2.67), and autologous hematopoietic cell transplant (OR, 2.07; 95% CI, 1.34‐3.20). Late effects (OR, 1.70; 95% CI, 1.31–2.20), highest medical expenses (OR, 1.65; 95% CI, 1.22–2.22), living in the most advantaged area (OR vs. the most deprived area = 1.60; 95% CI, 1.15–2.22), and shorter distance from LTFU care center (<12 miles) also increased attendance.ConclusionsPatients who are apparently healthy as well as socially disadvantaged and living far away from the center are less likely to attend LTFU care.Plain Language Summary
Among 2341 adult childhood cancer survivors contacted between 2012 and 2020, 33% attended at least one long‐term follow‐up visit.
Clinical factors related to attendance were multimodal treatment of first cancer (combining chemotherapy and radiotherapy), stem cell transplant, type of diagnosis (bone tumor and central nervous system primitive tumor), late effects (at least one disease among second malignancy, heart disease, or stroke), and highest medical expenses.
In addition, the study identified social and spatial inequalities related to attendance, with independent negative effects of distance and social deprivation on attendance, even though the medical costs related to the long‐term follow‐up examinations are covered by the French social security system.
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