Rurality of Residence and Distance to Clinic Are Risk Factors for Non-engagement in Childhood Cancer Survivor Care

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.

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.

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)].

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.

This analysis reveals that rural CCS are at risk for disparate care. Further studies are needed to determine barriers to care.