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Abstract：
Adolescent and young adult cancer survivors require lifelong healthcare to address the late effects of therapy. We examined the impact of different provider models of long-term follow-up (LTFU) care on adherence to recommended surveillance.
We conducted a retrospective cohort study using administrative health databases in Ontario, Canada. Five-year survivors were identified from IMPACT, a database of patients aged 15-20.9 years at diagnosis of six cancers between 1992 and 2010. We defined three models of LTFU care hierarchically: specialized survivor clinics (SCCs), general cancer clinics (GCCs), and family physician (FP). We assessed adherence to the Children\'s Oncology Group surveillance guidelines for cardiomyopathy and breast cancer. Multistate models assessed adherence transitions and impacts of LTFU attendance.
A total of 1574 survivors were followed for a mean of 9.2 years (range 4.3-13.9 years) from index (5-year survival). The highest level of LTFU attended in the first 2-years post-index was a GCC (47%); only 16.7% attended a SCC. By the end of study, 72% no longer attended any of the models of care and only 2% still attended an SCC. Among 188 survivors requiring breast cancer surveillance, 6.9% were adherent to their first required surveillance testing. Attendance at a SCC in the previous year and higher cumulative FP or GCC visits increased the rate of subsequently becoming adherent. Among 857 survivors requiring cardiomyopathy surveillance, 11% were adherent at study entry. Each subsequent SCC visit led to an 11.3% (95% CI: 1.05-1.18) increase in the rate of becoming adherent.
LTFU attendance and surveillance adherence are sub-optimal. SCC follow-up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve LTFU attendance and promote surveillance adherence.
We conducted a retrospective cohort study using administrative health databases in Ontario, Canada. Five-year survivors were identified from IMPACT, a database of patients aged 15-20.9 years at diagnosis of six cancers between 1992 and 2010. We defined three models of LTFU care hierarchically: specialized survivor clinics (SCCs), general cancer clinics (GCCs), and family physician (FP). We assessed adherence to the Children\'s Oncology Group surveillance guidelines for cardiomyopathy and breast cancer. Multistate models assessed adherence transitions and impacts of LTFU attendance.
A total of 1574 survivors were followed for a mean of 9.2 years (range 4.3-13.9 years) from index (5-year survival). The highest level of LTFU attended in the first 2-years post-index was a GCC (47%); only 16.7% attended a SCC. By the end of study, 72% no longer attended any of the models of care and only 2% still attended an SCC. Among 188 survivors requiring breast cancer surveillance, 6.9% were adherent to their first required surveillance testing. Attendance at a SCC in the previous year and higher cumulative FP or GCC visits increased the rate of subsequently becoming adherent. Among 857 survivors requiring cardiomyopathy surveillance, 11% were adherent at study entry. Each subsequent SCC visit led to an 11.3% (95% CI: 1.05-1.18) increase in the rate of becoming adherent.
LTFU attendance and surveillance adherence are sub-optimal. SCC follow-up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve LTFU attendance and promote surveillance adherence.
摘要：
青少年和年轻的成年癌症幸存者需要终身医疗保健，以解决治疗的后期影响。我们研究了长期随访（LTFU）护理的不同提供者模式对遵守推荐监测的影响。
我们使用安大略省的行政卫生数据库进行了一项回顾性队列研究，加拿大。从IMPACT中确定了5年的幸存者，1992年至2010年间诊断为6种癌症的15-20.9岁患者的数据库。我们分层定义了三种LTFU护理模型：专门的幸存者诊所(SCC)，普通癌症诊所（GCC），家庭医生（FP）。我们评估了儿童肿瘤组心肌病和乳腺癌监测指南的依从性。多状态模型评估了LTFU出勤的依从性过渡和影响。
根据指数（5年生存率），共对1574名幸存者进行了平均9.2年（范围4.3-13.9年）的随访。在索引后的头两年中，参加LTFU的最高水平是GCC（47％）；只有16.7％参加了SCC。在研究结束时,72%的人不再参加任何模式的护理，只有2%的人仍然参加SCC。在188名需要乳腺癌监测的幸存者中，6.9%的人坚持他们的第一次监测测试。前一年参加SCC以及较高的FP或GCC累计访问次数增加了随后成为信徒的比率。在857名需要心肌病监测的幸存者中，11％的人在研究进入时坚持。随后的每次SCC访问导致粘附率增加11.3％（95％CI：1.05-1.18）。
LTFU出勤率和监测依从性是次优的。SCC随访与更高的依从性相关，但是很少有幸存者得到这样的照顾，这个比例随着时间的推移而减少。需要采取干预措施来提高LTFU的出勤率并提高监测依从性。
我们使用安大略省的行政卫生数据库进行了一项回顾性队列研究，加拿大。从IMPACT中确定了5年的幸存者，1992年至2010年间诊断为6种癌症的15-20.9岁患者的数据库。我们分层定义了三种LTFU护理模型：专门的幸存者诊所(SCC)，普通癌症诊所（GCC），家庭医生（FP）。我们评估了儿童肿瘤组心肌病和乳腺癌监测指南的依从性。多状态模型评估了LTFU出勤的依从性过渡和影响。
根据指数（5年生存率），共对1574名幸存者进行了平均9.2年（范围4.3-13.9年）的随访。在索引后的头两年中，参加LTFU的最高水平是GCC（47％）；只有16.7％参加了SCC。在研究结束时,72%的人不再参加任何模式的护理，只有2%的人仍然参加SCC。在188名需要乳腺癌监测的幸存者中，6.9%的人坚持他们的第一次监测测试。前一年参加SCC以及较高的FP或GCC累计访问次数增加了随后成为信徒的比率。在857名需要心肌病监测的幸存者中，11％的人在研究进入时坚持。随后的每次SCC访问导致粘附率增加11.3％（95％CI：1.05-1.18）。
LTFU出勤率和监测依从性是次优的。SCC随访与更高的依从性相关，但是很少有幸存者得到这样的照顾，这个比例随着时间的推移而减少。需要采取干预措施来提高LTFU的出勤率并提高监测依从性。
