Treatment-Related and Social Determinants of Transition From Pediatric to Adult Cancer Survivorship Care

Abstract

Objective: Adolescent and young adult (AYA) survivors of pediatric cancer require risk-based follow-up care to mitigate long-term health concerns yet estimates suggest less than 50% of AYA cancer survivors successfully transition from pediatric to adult-based survivorship care. Several treatment-related and social factors may impact timely transition from pediatric to adult-based survivorship care, including socioeconomic status, treatment history, and geographic location, but few studies have investigated these factors and no studies have examined how they impact age of transition. The purpose of this study was to evaluate predictors of 1) transition from pediatric to adult-based survivorship care and 2) older age at transition. Methods: Survivors of pediatric cancer who attended a Midwest Hospital based survivorship clinic (N = 203) consented to participate in a pediatric cancer survivorship registry. Demographic and illness-related variables were collected at the time of consent. Binary logistic regression examined commercial insurance, sex, distance to hospital, rurality, cancer type, and treatment intensity as predictors of transition (i.e., attended at least one survivorship appointment) and age group at transition. Results: Findings demonstrated that survivors with commercial insurance, those who lived closer to the hospital (<30 miles), and those who underwent more intense treatment regimens were more likely to transition from pediatric to adult-based care, than those without commercial insurance, who lived farther away, and who had comparatively less intense treatment. People who lived closer to the hospital were more likely to transition at an older age (26–32). Conclusions: These barriers and facilitators provide important clinical implications for providers.

Implications for Impact Statement

Findings of the present study suggest that there are several barriers that survivors of pediatric cancer face that impede their ability to receive important, annual follow-up care. These barriers include having non-commercial insurance, living more than 30 miles away from the hospital, and being considered “low risk.” Practitioners and policymakers should consider these barriers in order to develop strategies to facilitate the transition process, as survivorship care may be crucial to optimize long-term health outcomes.