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Cancer. 2015 Dec 15;121(24):4389-97. doi: 10.1002/cncr.29679. Epub 2015 Sep 25.

Specialized survivor clinic attendance is associated with decreased rates of emergency department visits in adult survivors of childhood cancer.

Author information

1
Institute for Clinical Evaluative Sciences, Toronto, Canada.
2
Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
3
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
4
Pediatric Oncology Group of Ontario, Toronto, Canada.
5
Department of Pediatrics, University of Toronto, Toronto, Canada.
6
Department of Radiation Oncology, University of Toronto, Toronto, Canada.
7
Princess Margaret Cancer Centre, Toronto, Canada.

Abstract

BACKGROUND:

Survivors of childhood cancer are at considerable risk of experiencing treatment-related adverse health outcomes. To provide survivors with specialized care focused on these risks during adulthood, the government of Ontario funded a provincial network of specialized survivor clinics in 1999. The aim of this study was to determine whether prior attendance at survivor clinics by adult survivors of childhood cancer was associated with rates of emergency department (ED) visits.

METHODS:

This was a population-based, retrospective cohort study using multiple linked administrative health databases. The cohort consisted of all adult survivors of childhood cancer diagnosed between January 1, 1986 and December 31, 2005 in Ontario, Canada. A recurrent event regression model was used to evaluate the association between prior attendance at survivor clinics and the rate of ED visits; adjustments were made for individual, demographic, treatment, and provider characteristics.

RESULTS:

The study consisted of 3912 adult survivors of childhood cancer. Individuals who had at least 1 prior visit to a survivor clinic had a 19% decreased rate of ED visits in comparison with individuals who had not visited a survivor clinic (adjusted relative rate, 0.81; 95% confidence interval, 0.78-0.85). Each additional prior visit to a survivor clinic was associated with a 5% decrease in the rate of ED visits (adjusted relative rate, 0.95; 95% confidence interval, 0.93-0.96). These results were independent of whether or not survivors received care from a primary care physician.

CONCLUSIONS:

Attendance at a specialized survivor clinic was significantly associated with decreased ED visits among adult survivors of childhood cancer.

KEYWORDS:

adult survivors of childhood cancer; emergency department visits; recurrent event model; relative rate; specialized survivor clinics; time-varying covariates

PMID:
26406998
DOI:
10.1002/cncr.29679
[Indexed for MEDLINE]
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