Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_37_2956 - Demographic Predictors of Missed Follow Up Among Breast Cancer Patients Treated at a Large Multi-Site Academic Institution

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Demographic Predictors of Missed Follow Up Among Breast Cancer Patients Treated at a Large Multi-Site Academic Institution
J. A. Holmes1, S. Rachidi2, R. C. Zellars1, and T. Lautenschlaeger1; 1Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 2Indiana University Department of Radiation Oncology, Indianapolis, IN

Purpose/Objective(s): An increasing number of patients are transitioning from cancer treatment to cancer survivorship with over 20 million survivors expected by 2026. A critical component of survivorship care for breast cancer patients is detecting disease recurrence early when it is most likely to be curable. However, little is known about how many patients miss follow up appointments and what groups of patients are more likely to be lost in survivorship. Using data from 1999-2016 from a large multi-site single institution we examined the proportion of breast cancer patients who were lost to follow up. We further examined demographic predictors of being lost to follow up.

Materials/Methods: Appointment data for patients with breast cancer diagnosed in the Indiana University health care system was linked with cancer registry data. Patients were classified as having a missed follow up if they had a no show, canceled or rescheduled appointment with their oncologist without a subsequent attended appointment within 60 days. Appointments were excluded if they were within 180 days of patient death. Cancer registry data included disease site, patient race, age and census level demographics including income and rural/urban. Univariate comparisons were performed using Chi squared, and a multivariable logistic regression model adjusting for race, age, income, rural/urban continuum and insurance was constructed.

Results: Data from 5,170 individual patients and 100,229 appointments were analyzed. The median age was 57 years, 15% of the patients were African American and 5% lived in the most rural (non-core) areas. Overall 17.7% of patients had at least one missed follow up (range 0-6). On univariate analysis patients without insurance, with Medicaid, from lower income counties and patients from non-core areas were more likely to have a missed follow up (p<0.001 for each group). On multivariable modeling older patients were less likely to have a missed appointment (OR 0.90 per 5 years, p<0.001) while patients from the most rural counties (OR 1.79, p=0.002) and with the lowest income (OR 1.29, p=0.03) remained more likely to have missed follow up appointments. There was a trend towards higher odds of missed appointments for African American patients (OR 1.22, p=0.08).

Conclusion: Almost one in five breast cancer patients had a missed follow up appointment in our registry, and this appeared to be more common among vulnerable patient populations. More research is needed on how to address disparities in follow up care, and how missed follow up might affect breast cancer patient survival.

Author Disclosure: J.A. Holmes: None. S. Rachidi: None. R. Zellars: Board Member; Indiana University Health Physicians. T. Lautenschlaeger: None.

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