Transition outcomes in a diverse cohort of higher-risk young adult survivors of childhood cancer in an established care model.

Abstract

Purpose: Young adult survivors of childhood cancer frequently experience transition failure when transferred to adult-focused survivorship care, yet associated factors within specific care models remain poorly studied.

Methods: This retrospective cohort study included higher-risk young adult survivors transitioned from Children's Hospital Los Angeles to an affiliated adult-focused survivorship clinic from 2010 to 2018 using a protocolized pathway. Transition failure was defined as no documented adult-clinic visit within 2 years of transition launch. Late effects were defined per the Common Terminology Criteria for Adverse Events (CTCAE, v5.0).

Results: The sample (N = 289) had mean age 22.9 years (range 17-53), was 54.0% male, and 52.2% Hispanic. Transition failure occurred in 143 (49.5%). In multivariable analyses, significantly lower odds of failure (OR, 95% CI) were observed for multiple prior pediatric survivorship visits (2 vs. 1: 0.28, 0.15-0.55; ≥ 3 vs. 1: 0.42, 0.20-0.87), higher education (college vs. high school: 0.50, 0.26-0.95), and high-dose anthracyclines (vs. none/low: 0.29, 0.11-0.77), with borderline higher odds for CTCAE-defined psychiatric disorders (2.04, 0.99-4.21). In exploratory ethnicity-stratified analysis, psychiatric disorders were associated with higher odds of failure only among Hispanic survivors (4.06, 1.37-12.01), with lower odds for age ≥ 22 years at transition (0.39, 0.16-0.95).

Conclusions: At 2 years, half of survivors experienced transition failure, which was associated with fewer prior survivorship visits and lower educational attainment; psychiatric comorbidity showed a borderline association.

Implications for cancer survivors: Even within a highly structured model, early survivorship transition failure is common, and identifiable patient subsets need additional support. More research concerning post-transition barriers is needed.