Associates of Engagement in Adult-Oriented Follow-Up Care for Childhood Cancer Survivors

doi:10.1016/j.jadohealth.2016.08.018

Journal of Adolescent Health

Volume 60, Issue 2, February 2017, Pages 147-153

https://doi.org/10.1016/j.jadohealth.2016.08.018 Get rights and content

Abstract

Purpose

Understanding how to predict appropriate uptake of adult-oriented medical care is important for adult patients with pediatric-onset chronic health conditions with continued health vulnerability. We examined associates of engagement in adult survivors of childhood cancer following transfer to adult-oriented care.

Methods

Adult survivors of childhood cancer (N = 80), within 1–5 years post transfer from pediatric to adult-oriented follow-up care, completed assessments of engagement with recommended adult-oriented follow-up care and psychosocial and transition readiness measures. Measures were validated with adolescent and young adults and/or intended to measure readiness to transition to adult care.

Results

Earlier age at diagnosis, parental involvement in health care decision-making, higher motivation, and increased comfort speaking to providers about health concerns were significantly associated with attendance at adult-oriented follow-up care visits.

Conclusions

Associates of engagement in adult care are complex, representing social-ecological variables. Current measures of transition readiness or adolescent and young adult health-related measures may not adequately capture the associates of engagement in care or identify targets of intervention to promote successful transfer of care. Identifying patients at risk for loss to follow-up will be useful to design interventions for young adult survivors of childhood cancer and other young adults with pediatric-onset chronic conditions who require ongoing adult-oriented care.

Section snippets

Methods

Descriptions about the cohort and rates of engagement in follow-up care after transfer were previously reported (Szalda et al. [11]) and briefly summarized below.

Demographics, disease-related variables and engagement in care

Eighty YAS completed the study. The average age of YAS was 27.7 years (range 23–36 years). Participants were 51% female. The majority of YAS surveyed were non-Hispanic Caucasian (94%), single (79%), and held a college degree (78%). Few (7%) of YAS were uninsured. The average age at diagnosis was 10.4 years (range .5–22 years), and the mean time since diagnosis was 17.1 years (range 4.5–32.4). Multiple diagnoses were represented including leukemia (n = 31, 39%), lymphoma (n = 22, 28%), brain

Discussion

This study represents the first to describe associates of engagement in adult care for childhood cancer survivors formally transferred out of pediatrics and one of the few to do so among all of pediatric chronic health conditions [3], [4], [15], [33], [34]. Our findings indicate that success in the transfer of care is determined by many factors, many of which are determined by social-ecological components of transition readiness. Specifically, earlier age at diagnosis, having insurance,

Acknowledgments

This work has been presented, in part, as an oral presentation at the Seventh International Nursing Conference on Child and Adolescent Cancer Survivorship.

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: Conflicts of Interest: The authors have no financial relationships relevant to this article to disclose.

View full text

Original articleAssociates of Engagement in Adult-Oriented Follow-Up Care for Childhood Cancer Survivors

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Demographics, disease-related variables and engagement in care

Discussion

Acknowledgments

J Am Coll Cardiol

J Adolesc Health

J Biomed Inform

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

Transition planning for youth with special health care needs: Results from the National Survey of Children With Special Health Care Needs

Pediatrics

Addressing transition to adult health care for adolescents with special health care needs

Pediatrics

Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects

Pediatrics

Medical care in long-term survivors of childhood cancer: A report from the childhood cancer survivor study

J Clin Oncol

Supporting the health care transition from adolescence to adulthood in the medical home

Pediatrics

A consensus statement on health care transitions for young adults with special health care needs

Pediatrics

Chronic health conditions in adult survivors of childhood cancer

N Engl J Med

Childhood cancer survivors: Transition to adult-focused risk-based care

Pediatrics

Engagement and experience with cancer-related follow-up care among young adult survivors of childhood cancer after transfer to adult care

J Cancer Surviv

Factors influencing long-term follow-up clinic attendance among survivors of childhood cancer

J Cancer Surviv

Factors that contribute to post-treatment follow-up care for survivors of childhood cancer

J Cancer Surviv

Medical screening participation in the childhood cancer survivor study

Arch Intern Med

Identifying predictors of longitudinal decline in the level of medical care received by adult survivors of childhood cancer: A report from the childhood Cancer survivor study

Health Serv Res

Original article
Associates of Engagement in Adult-Oriented Follow-Up Care for Childhood Cancer Survivors