Rurality of Residence and Distance to Clinic Are Risk Factors for Non-engagement in Childhood Cancer Survivor Care.
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BACKGROUND: Childhood cancer survivors (CCS) are at risk of chronic health conditions due to their cancer and treatment. Cancer survivor programs offer screening services; however, there are disparities in care. Rurality has been understudied; thus, we examined whether rural CCS are at increased risk for non-engagement in survivor care compared with their urban counterparts. METHODS: This retrospective analysis of an institutional CCS cohort evaluated noninitiation of survivor care within 3 years of eligibility and noncontinuation (i.e., no subsequent visit within 18 months of an initial visit). Rurality was defined using rural-urban commuting area codes. Distance from clinic was defined as near (<25 miles) or far (≥25 miles). Outcomes were compared among rural versus urban and urban-near, urban-far, and rural-far CCS using multivariable logistic regressions and cumulative event analysis. RESULTS: Of 1,515 CCS, 10.7% were rural. Compared with urban CCS, rural CCS had higher odds of survivor care noninitiation [27% vs. 35%; adjusted OR (aOR) = 1.55 (1.06-2.23)] and noncontinuation [23% vs. 32%; aOR = 1.87 (1.17-2.93)]. When including distance, rural-far and urban-far survivors were more likely to not initiate care compared with urban-near survivors [rural-far aOR = 1.95 (1.30-2.90); urban-far aOR = 1.66 (1.28-2.15)], whereas only rural-far CCS were more likely to not continue care [aOR = 2.14 (1.26-3.56)]. CONCLUSIONS: A higher proportion of rural CCS did not initiate or continue survivor care compared with urban-near CCS. Rurality and distance to clinic are important in survivor care. IMPACT: This analysis reveals that rural CCS are at risk for disparate care. Further studies are needed to determine barriers to care.