Clinical and social determinants of sustained head and neck cancer survivorship clinic attendance.

PURPOSE: Despite its importance, little is known about engagement with structured, multidisciplinary head and neck cancer (HNC) survivorship care. We sought to identify clinical and sociodemographic factors associated with sustained attendance at an HNC Survivorship Clinic. METHODS: Our retrospective cohort of 625 HNC patients was divided into a subset of patients who received radiotherapy (n = 510) and patients who did not (n = 115). We defined sustained attendance as 1) the total number of visits that occurred before completing treatment and within three years post-treatment, and 2) adherence scores, calculated as the number of timeframes during which at least one visit occurred: pre-treatment completion (for the radiotherapy subset only) and one-, two-, and three-years post-treatment. We used Fisher's exact test for descriptive statistics and Poisson regression to estimate prevalence ratios (PRs) for sustained attendance. RESULTS: In the overall cohort, 248 patients (39.7%) had only one visit to the Survivorship Clinic. In the radiotherapy subset, 211 patients (41.4%) had an adherence score of 1, compared to 81 (70.4%) in the non-radiotherapy subset. In adjusted analysis, treatment with radiotherapy was associated with more total visits (PR: 1.41, 95% confidence interval [CI]: 1.19-1.68), while greater neighborhood socioeconomic deprivation (PR: 0.82, 95% CI: 0.70-0.97) and farther distance from the Clinic (PR: 0.81, 95% CI: 0.69-0.95) were associated with fewer total visits. CONCLUSIONS: Clinical and sociodemographic factors are independently associated with sustained attendance at an HNC Survivorship Clinic. IMPLICATIONS FOR CANCER SURVIVORS: Disparities in engagement with HNC survivorship care highlight the need for targeted interventions to improve adherence to follow-up recommendations.

Duke Scholars

Author Sandra Sue Stinnett Biostatistics & Bioinformatics, Division of Biostatistics

Author Yvonne Marie Mowery Radiation Oncology

Author Nosayaba Osazuwa-Peters Head & Neck Surgical Oncology