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

Abstract

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. This retrospective analysis included patients eligible for receipt of a survivorship care plan in the institutional survivorship program at a comprehensive pediatric cancer center following initial diagnosis between 2002 and 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 survivorship care plan receipt at an initial survivorship program visit with overall survival and event-free survival, adjusting for sociodemographic and cancer-related factors. Among 3366 survivors, 1883 (55.9%) received a survivorship care plan, at median of 0.67 years (interquartile range [IQR] = 0.30-1.67 years) post-eligibility. Compared with those who received a survivorship care plan, survivors without were more likely to be older at eligibility (mean age = 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 years) from eligibility. In multivariable models, survivorship care plan receipt (vs nonreceipt) was associated with a lower risk of death (overall survival: adjusted hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.39 to 0.97; P = .04; event-free survival: adjusted HR = 0.73, 95% CI = 0.54 to 0.99; P = .04). Engagement in survivorship care, indicated by survivorship care plan receipt, was associated with superior overall and event-free survival in childhood cancer survivors, underscoring its importance in improving long-term outcomes.