Journal of Cancer Survivorship

, Volume 12, Issue 2, pp 196–205 | Cite as

An investigation of survivorship clinic attendance among childhood cancer survivors living in a five-state rural region

  • Judy Y. Ou
  • Rochelle R. Smits-Seemann
  • Yelena P. Wu
  • Jennifer Wright
  • Anne C. Kirchhoff



Cancer survivorship clinics manage cancer-related health complications and are available primarily in urban areas. We examine how demographic, clinical, and geographic-based characteristics are associated with attendance at the only pediatric survivorship clinic in a largely rural, multistate region.


One thousand eight hundred sixteen cancer survivors were diagnosed at age ≤ 25 from 1986 to 2005 while living in the region. Cox models incorporating death as a competing risk and generalized estimating equations calculated hazards ratios (HR) for characteristics measured at the clinic’s opening. Subjects were followed from the clinic opening their first visit, death, emigration from the catchment area, or December 31, 2014.


Five percent of survivors visited the clinic. Attendance is positively associated with a leukemia or lymphoma diagnosis (HR = 3.32, 95% confidence interval [CI] = 1.72–6.78 vs CNS tumors), previous relapse (HR = 1.78, 95% CI = 1.00–3.19), and residing >100 mi from the clinic (HR = 2.05, 95% CI 1.03–4.10). Survivors aged ≥ 31 years at clinic opening (HR = 0.19, 95% CI = 0.07–0.54) are less likely to attend than younger survivors. Residence between 16 and 100 mi had an inverse association with attendance, although not significant.


Survivorship clinics are not widely attended by survivors in this catchment region. Efforts should be made to recruit survivors aged ≥ 31 and diagnosed with CNS tumors. Distance has a complex association with attendance, which could be attributed to the limited availability of preventative services in regions > 100 mi from the clinic.

Implications for Cancer Survivors

Survivors living in this catchment region may not be receiving care necessary to prevent severe late effects.


Survivorship Pediatric oncology Geography Late effects 


Funding information

The authors thank Hyundai Hope on Wheels and Primary Children’s Hospital Foundation for their support of this project.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Judy Y. Ou
    • 1
    • 2
    • 3
  • Rochelle R. Smits-Seemann
    • 1
    • 2
    • 4
  • Yelena P. Wu
    • 1
    • 2
  • Jennifer Wright
    • 2
    • 5
  • Anne C. Kirchhoff
    • 1
    • 2
  1. 1.Cancer Control and Population Sciences, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA
  2. 2.Division of Pediatric Hematology/Oncology, Department of PediatricsUniversity of UtahSalt Lake CityUSA
  3. 3.Salt Lake CityUSA
  4. 4.Department of Institutional Research and ReportingSalt Lake Community CollegeSalt Lake CityUSA
  5. 5.Primary Children’s HospitalSalt Lake CityUSA

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