Living Beyond Cancer: How Distance Impacts Childhood Cancer Survivorship Care

PROJECT SUMMARY/ABSTRACT Significance: Over 15,000 children aged <20 years will be diagnosed with cancer in 2023, but due to advancements in treatments and therapies, 85% of these children are expected to join the growing population of childhood cancer survivors (CCS) currently living in the US. On average, CCS will experience over 17 chronic health conditions by age 50, contributing to health complications (physical, mental, psychosocial) and early mortality. Access to specialized long-term healthcare is a barrier in achieving equity in quality and longevity of life, especially in disadvantaged populations, and this barrier is magnified as the population of CCS continues to expand. Existing research has shown that proximity to providers confers advantages in frequency of care and better health outcomes. However, partially attributable to the availability of adequate datasets, these studies have only examined the role of distance as it relates to cancer incidence rather than post- treatment survivorship. For CCS, and especially adolescent and young adults (AYA), survivors’ communication between and/or fluctuation of care providers adds complexity to sustained healthcare treatment across the life course. Aims: This project will (1) characterize the proximity of AYA survivors to Children’s Oncology Group (COG) survivorship care across the US, (2) determine the association between distance to care and early mortality, and examine whether this is influenced by socioeconomic status (SES) and/or race/ethnicity in AYA survivors. Approach: The proposed secondary analysis will leverage AYA cancer patient data from the COG’s Children’s Cancer Research Network (protocol #ACCRN07). Previous work to geocode patient residence and complete (pre- and post-diagnosis) residential history has allowed for study of patient residence in relation to survivorship care. Aim 1 analysis will measure distance to care and characterize patients’ residential environment (individual- and area-level characteristics). Poisson regression will be used to assess the number of survivorship care contacts per unit area (density). Aim 2 will assess the relationship between distance to care and early mortality (<5 years post-diagnosis) using Cox proportional hazards models adjusting for age and sex. Mediation analysis will be used to explore the influence of SES and we will evaluate race/ethnicity as a confounder. Fellowship Information: The applicant is a PhD student in Epidemiology at the University of Minnesota and a predoctoral trainee in the NICHD-funded T32 training program in Population Health Science. Through coursework and mentoring on pediatric cancer epidemiology, geospatial analysis, and health disparities along with guidance on communicating findings and writing grants, the proposed training plan will build on Ms. Thomas’ existing research skills. This training will enhance her ability to complete her dissertation research and become an independent cancer epidemiology researcher with expertise in childhood cancer survivorship.