P1089 - Long Term Follow Up in the US Department of Defense Pediatric Leukemia Survivor Population

Background: Pediatric cancer survivors are a growing segment of the United States population with unique long-term health needs. A report from the St Jude lifetime cohort estimated that as many as 95.2% of cancer survivors will have at least one chronic health condition and 80% will have at least one serious, disabling, or life-threatening condition. The Children’s Oncology Group Long Term Follow Up Guidelines offers detailed guidelines and recommendations for screening for these late effects of treatment and have been in place since 2003. Prior attempts have been made to quantify compliance with follow up guidelines and often use either survey methodology of larger cohorts or are single institution record reviews. Results from these studies have shown varying compliance with follow up, with rates ranging from 28% - 73% at 10 years.

Objective: To assess rates of adherence to recommended long-term health screening among pediatric acute lymphoblastic leukemia (ALL) cancer survivors within the US Department of Defense (DoD) and to identify potential risk factors contributing to patient compliance.
Design/

Method: This retrospective cohort study used data from the US DoD Military Health System (MHS) database and identified incident cases of pediatric ALL among child beneficiaries ages 2 -19 years old in the MHS across the 5-year period of 2007 – 2011. To assess survivorship outcomes, cases were required to maintain continuous eligibility for a minimum of 5 years after index diagnosis. Health screening measures assessed in this study include annual visits with oncology as well as appropriate screening for cardiovascular disease, osteoporosis, endocrinopathy, hepatotoxicity and mental health issues, as outlined in the Children’s Oncology Group Long Term Follow Up Guidelines, version 5. Rates of adherence were calculated across the full study cohort for each health screening measure, and regression analyses were performed to determine which patient and clinical characteristics appeared to contribute to improved compliance.

Results: 136 cases of study-eligible ALL patients were identified. Within our cohort 130 patients (95.6%) meet the minimum follow up requirements for an annual complete blood count. For the remaining follow up metrics, 123 patients (90.4%) had ≥1liver function screening, 111 (81.6%) had ≥1 echocardiogram, 47 (34.6%) had ≥1 bone density scan, 72 (52.9%) had ≥1 mental health visit, and 6 (26.1%) had ≥1 endocrinopathy screening (among patients ≥14 years old) during the follow up period.

Conclusion: The MHS provides universal access to healthcare for all beneficiaries at little to no out-of-pocket cost to the sponsor and their family while reflecting the socioeconomic diversity of the United States. Our results indicate that universal access to care across military and civilian facilities enables improved compliance with long-term recommended health screening and provide a mechanism for future studies on the long term outcomes of these screening guidelines.