Liberty F Strange, Rebecca S Williamson Lewis, Xu Ji, Karen E Effinger
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引用次数: 0
Abstract
Background: Childhood cancer survivors (CCS) are at risk of chronic health conditions due to cancer and its treatment. Cancer survivor programs offer screening; however, there are disparities in care. Rurality has been understudied; thus we examined whether rural CCS are at increased risk for non-engagement in survivor care compared to urban counterparts.
Methods: This retrospective analysis of an institutional CCS cohort evaluated non-initiation of survivor care within 3 years of eligibility and non-continuation (i.e., no subsequent visit within 18 months of an initial visit). Rurality was defined using Rural-Urban Commuting Area (RUCA) codes. Distance from clinic was defined as near (<25 miles) or far (≥25 miles). Outcomes were compared among rural versus urban and urban-near, urban-far, and rural-far CCS using multivariable logistic regressions and cumulative event analysis.
Results: Of 1,515 CCS, 10.7% were rural. Compared with urban CCS, rural CCS had higher odds of survivor care non-initiation (27% vs. 35%, aOR 1.55 [1.06-2.23]) and non-continuation (23% vs. 32%, aOR 1.87 [1.17-2.93]). When including distance, rural-far and urban-far survivors were more likely to not initiate care compared with urban-near survivors (rural-far aOR 1.95 [1.30-2.90], urban-far 1.66 [1.28-2.15]), while only rural-far CCS were more likely to not continue care (aOR 2.14 [1.26-3.56]).
Conclusions: A higher proportion of rural CCS did not initiate or continue survivor care compared to urban-near CCS. Rurality and distance to clinic is important in survivor care.
Impact: This analysis reveals that rural CCS are at risk for disparate care. Further studies are needed to determine barriers to care.
背景：儿童癌症幸存者（CCS）由于癌症及其治疗而面临慢性健康状况的风险。癌症幸存者项目提供筛查；然而，在护理方面存在差异。农村问题一直没有得到充分研究；因此，我们研究了农村CCS与城市CCS相比，不参与幸存者护理的风险是否更高。方法：对一个机构CCS队列进行回顾性分析，评估3年内未开始幸存者护理和未继续治疗（即首次就诊后18个月内未进行后续随访）。乡村性采用城乡通勤区（RUCA）编码定义。离诊所的距离定义为近(结果：1515个CCS中，10.7%是农村。与城市CCS相比，农村CCS的幸存者护理非开始（27% vs. 35%, aOR 1.55[1.06-2.23]）和非继续（23% vs. 32%, aOR 1.87[1.17-2.93]）的几率更高。当包括距离时，与城市附近的幸存者相比，农村远和城市远的幸存者更有可能不开始护理（农村远的aOR为1.95[1.30-2.90]，城市远的aOR为1.66[1.28-2.15]），而只有农村远的CCS更有可能不继续护理（aOR为2.14[1.26-3.56]）。结论：与城市附近的CCS相比，农村CCS患者没有开始或继续幸存者护理的比例更高。农村和离诊所的距离在幸存者护理中很重要。影响：该分析表明，农村CCS面临着分散护理的风险。需要进一步的研究来确定护理障碍。
期刊介绍：
Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.
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