K Reynolds1,2, M Spavor3,4, Y Brandelli5,6, C Kwok5,6, Y Li5,6,7, M Disciglio8, L E Carlson5,6,7, F Schulte5,9,10,11, R Anderson11,12, P Grundy8,13, J Giese-Davis5,6,7. 1. Long Term Survivor's Clinic, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada. 2. Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada. maria.spavor@ahs.ca. 4. Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada. maria.spavor@ahs.ca. 5. Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, Alberta, Canada. 6. Alberta Health Services, Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada. 7. Department of Psychosocial Resources, Alberta Health Services Cancer Care-Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, T2S 3C1, Canada. 8. Northern Alberta Childhood Cancer Survivor Program, 4E2, Stollery Children's Hospital, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada. 9. Division of Medical Science, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 10. Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada. 11. Alberta Children's Hospital, Calgary, Alberta, Canada. 12. Department of Oncology, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada. 13. Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
Abstract
PURPOSE: Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up. METHODS: ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior. RESULTS: One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values. CONCLUSION: This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs. IMPLICATIONS FOR CANCER SURVIVORS: ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
PURPOSE: Few studies have compared follow-up-care models for adult survivors of childhood cancer (ASCCs), though choice of model could impact medical test adherence, and health-related quality of life (QOL). This study compared two follow-up-care models, cancer-center-based versus community-based, for ASCCs in Alberta, Canada, to determine which model would demonstrate greater ASCC adherence to guideline-recommended medical screening tests for late effects, QOL, physical symptoms, and adherence to yearly follow-up. METHODS: ASCC discharged to a community model (over 15 years) and those with comparable birth years (1973-1993) currently followed in a cancer center model were recruited via direct contact or multimedia campaign. Chart review identified chemotherapeutic and radiation exposures, and required medical late effect screening tests. ASCCs also completed questionnaires assessing QOL, physical symptoms, and follow-up behavior. RESULTS: One hundred fifty-six survivors participated (community (n = 86); cancer center (n = 70)). Primary analysis indicated that cancer center ASCCs guideline-recommended total test adherence percentage (Mdn = 85.4%) was significantly higher than the community model (Mdn = 29.2%, U = 3996.50, p < 0.0001). There was no significant difference in QOL for cancer center ASCCs (M = 83.85, SD = 20.55 versus M = 77.50, SD = 23.94; t (154) = 1.77, p = 0.078) compared to community-based ASCCs. Cancer center-based ASCCs endorsed from 0.4-7.1% fewer physical symptom clusters, and higher adherence to follow-up behavior in comparisons using effect sizes without p values. CONCLUSION: This study highlights the cancer center model's superiority for adherence to exposure-based medical late effect screening guidelines, cancer-specific follow-up behaviors, and the reporting of fewer physical complaints in ASCCs. IMPLICATIONS FOR CANCER SURVIVORS: ASCCs followed in a cancer center model likely benefit from earlier late-effects detection and opportunities for early intervention.
Entities:
Keywords:
COG guideline adherence; Childhood cancer; Late effects; Models of care; Quality of life; Survivorship
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