Survivorship care and mortality in a contemporary and diverse cohort of childhood cancer survivors.

Abstract

BACKGROUND Implementing quality survivorship care for the growing population of cancer survivors is a national priority. The impact of comprehensive survivorship care on survival among childhood cancer survivors is unknown. METHODS This retrospective analysis included patients eligible for receipt of a survivorship care plan (SCP) in the institutional survivorship program at a comprehensive pediatric cancer center following initial diagnosis between 2002-2016. We followed survivors from eligibility to 10 years, death, or December 31, 2020, whichever occurred earliest. Cox proportional hazards models estimated the association of SCP receipt at an initial survivorship program visit with overall survival (OS) and event-free survival (EFS), adjusting for sociodemographic and cancer-related factors. RESULTS Among 3,366 survivors, 1,883 (55.9%) received a SCP, at median of 0.67 years (interquartile range [IQR]=0.30-1.67) post-eligibility. Compared to those who received a SCP, survivors without were more likely to be older at eligibility (mean age [standard deviation] 11.8 [6.1] vs 11.2 [5.5] years, p = .002), non-Hispanic Black (29.5% vs 24.8%, p = .006), treated for central nervous system tumors (38.7% vs 12.4%, p < .001), or treated with surgery only (46.8% vs 1.2%, p < .001). Overall, 2.9% of survivors died at a median of 3.6 years (IQR = 2.3-5.4) from eligibility. In multivariable models, SCP receipt (vs non-receipt) was associated with a lower risk of death (OS adjusted hazard ratio [aHR]=0.62, 95% CI = 0.39-0.97, p = .04; EFS: aHR = 0.73, 95% CI = 0.54-0.99, p = .04). CONCLUSION Engagement in survivorship care, indicated by SCP receipt, was associated with superior overall and event-free survival in childhood cancer survivors, underscoring its importance in improving long-term outcomes.