Social Deprivation and Psychosocial Services Utilization in Pediatric Cancer Survivor Care Open Access
Jiwani, Zahra (Spring 2025)
Abstract
Introduction/Background: As pediatric cancer survivors live longer, the risk of adverse effects from their cancer treatment increases. Pediatric cancer survivor care is lifelong and requires repeated visits, screenings, and diagnostic tests. Barriers to survivor care that have previously been described in adult survivors of childhood cancer include poor socioeconomic status, lack of transportation, Black race, and lack of access to healthcare. Neighborhood and community characteristics have increasingly been highlighted as important factors in healthcare outcomes; therefore, it is important to assess their role in the survivor population. Further, after treatment, families have access to social work and psychological services, which may ameliorate some of the negative effects of external stressors. We hypothesize that patients living in areas of increased social deprivation, and those with decreased psychosocial service utilization, will be less likely to initiate and continue survivor care.
Objective: Evaluate factors that impact initiation and continuation of survivor care.
Methods: This single-institution retrospective review included survivors diagnosed at age <21 years between 2007-2017 who became eligible for survivor care (i.e., non-central nervous system tumor, alive with no evidence of disease at eligibility 2 years from therapy completion) between 2010-2019. The primary outcome was initiation of survivor care, as measured by attendance in the Aflac survivor clinic within 4 years of eligibility. Continuation of care was defined as a follow-up visit within 18 months of the initial visit. Patients were excluded if they were treated with surgery only or complete address data was not available. Address at time of eligibility was used to determine the Social Deprivation Index (SDI) quintile, with higher SDI scores corresponding to greater levels of deprivation. Psychology and social work interactions were collected from time off-therapy to eligibility. Chi-square and Fisher’s exact tests were used to look at differences in characteristics by SDI quintiles. Logistic regression models were used to determine associations of factors with initiation and continuation of survivor care. Subgroup analyses were performed to evaluate differences by tumor type.
Results: Of 1596 patients, 1180 (73.93%) were seen for an initial visit within survivor clinic. In multivariate models without insurance, lower odds of initiation were associated with age ≥18 years (aOR 0.33; CI 0.24-0.45), Black/non-Hispanic race (aOR 0.56; CI 0.42-0.74), and solid tumor diagnosis (aOR 0.31; CI 0.24-0.40). History of stem cell transplant was associated with higher odds of initiation (aOR 3.73; CI 2.07-6.72). SDI quintiles 1 (aOR 1.56; CI 1.06-2.30) and 3 (aOR 1.49; CI 1.02-2.17) were associated with higher odds of initiation of survivor care compared to SDI quintile 5. After adjusting for insurance, SDI was no longer significant but survivors with public insurance were less likely to initiate care (aOR 0.68; CI 0.52-0.89). Any level of psychology interaction was significantly associated with higher odds of initiation of survivor care [1-2 interactions (aOR 7.94; CI 5.12-12.25) and >2 interactions (aOR 5.35; CI 3.29-8.70)], while SDI was not a significant factor after adjustment for psychology interactions. In subgroup analyses, survivors with history of solid tumors living in areas with high social deprivation were less likely to initiate survivor care compared to those with low deprivation even after adjustment for psychology services. SDI quintile was not significant for patients with a history of hematologic malignancies, while psychology services remained significant. Age >10 years and solid tumor diagnosis were associated with lower odds of continuation of care; however, SDI was not associated with differences in continuation.
Conclusions: Survivors who interact with psychology after therapy completion are more likely to initiate survivor care regardless of tumor type. Survivors of solid tumors living in areas of highest social deprivation were less likely to initiate survivor care, while social deprivation did not influence survivors of hematologic malignancies or continuation of care for any survivors. More studies are needed to fully understand the role of psychology in initiation of survivor care and interventions are needed to support those at highest risk for care non-initiation.
Table of Contents
A. BACKGROUND……………………………………………………………………………………………1
B. METHODS………………………………………………………………………………………………….4
C. RESULTS……………………………………………………………………………………………………11
D. DISCUSSION……………………………………………………………………………………………..18
E. REFERENCES……………………………………………………………………………………………23
F. TABLES/FIGURES…………………………………………………………………………………….26
About this Master's Thesis
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
Social Deprivation and Psychosocial Services Utilization in Pediatric Cancer Survivor Care () | 2025-03-30 16:50:08 -0400 |
|
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|