Impact of survivorship care plans on mortality in a contemporary cohort of childhood cancer survivors.

Abstract

481 Background: Childhood cancer and its treatment predispose survivors to the risk of late effects, resulting in debilitating and life-threatening diseases. The heterogeneous construction and dissemination of survivorship care plans (SCPs) have raised the question of their ability to improve the quality of cancer survivorship care. This study aims to determine what populations of eligible patients were seen in a pediatric cancer survivor program and received a personalized SCP; and to investigate the association between receiving a SCP and overall mortality. Methods: This retrospective cohort study included patients treated for a newly diagnosed cancer at Children’s Healthcare of Atlanta (CHOA) in 2002-2016 who were ≥2 years post-treatment and in remission (i.e., eligibility to be seen in the Aflac Cancer Survivor Clinic of CHOA). Descriptive analyses were conducted to examine SCP receipt between 01/01/2005 and 12/31/2020 and mortality through 12/31/2020 based on linkage to the National Death Index. A multivariable cox proportional hazard model was used to estimate the association between SCP receipt and mortality, controlling for sex, race/ethnicity, and treatment with chemotherapy and/or radiation therapy. Results: Among 3,394 eligible pediatric cancer survivors, 1,894 (55.8%) received a SCP at a median of 0.7 years (Q1-Q3: 0.3-1.7 years) from eligibility for survivorship clinic. Recipients of a SCP were younger at original diagnosis (mean ± SD age: 7.7 ± 5.6 vs. 9.1 ± 6.0 years), more likely to be diagnosed with leukemia (82.9%) or lymphoma (70.7%) vs. CNS tumor (29.4%) or other solid tumor (35.1%) (p<0.01), and more likely to have received chemotherapy (73.7% vs. 9.0%, p<0.01) or radiation therapy (69.4% vs. 52.0%, p<0.01). Overall, 3.4% of patients were deceased at the end of follow-up (median follow-up from eligibility: 7.0 [Q1-Q3: 4.0-10.8 years]). Receipt of a SCP was associated with an improvement in survival in multivariable model (adjusted hazard ratio: 0.31 [95% CI: 0.31, 0.46]). Conclusions: Overall survival was superior in survivors who received a SCP compared to those who did not. Longitudinal follow-up of this cohort enables us to examine patterns of death and healthcare utilization to delineate the effectiveness of survivorship care, and to further define lifetime risk after contemporary treatment.