ASPO Abstracts
Discontinuation of survivorship care after head and neck cancer treatment
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2021
Abstract Body:
Purpose: Little is known about those who discontinue follow-up care, a population who may benefit from continued
engagement in care. Our objective was to characterize head and neck cancer patients who discontinue
survivorship care with their treating institution and identify factors associated with discontinuation.
Methods: Using our institution's cancer registry, we conducted a retrospective cohort study of patients diagnosed
with in situ or invasive head and neck cancer between January 1, 2014, and December 31, 2016, who received
cancer-directed therapy at the University of Iowa Hospitals and Clinics (UIHC). Eligible patients achieved cancer-
free status after curative-intent treatment and made at least one visit 90+ days after treatment completion. The
primary outcome was discontinuation of care, which we defined as a still-living survivor who has not returned to a
UIHC cancer clinic for twice the recommended follow-up interval between completion of cancer treatment and the
end of the study period (October 1, 2019). Demographic and oncologic factors were examined to identify
associations with discontinuation.
Results: We identified 449 patients meeting all inclusion criteria. Oral cavity was the most common primary site at
39.4% of patients, and 92.7% had invasive histology. The majority were men (70.2%); 61.0% were married or
partnered, and 28.3% were classified as rural. One hundred eight (24.1%) of the 449 eligible patients discontinued
follow-up care at UIHC during the study period. The mean time in follow-up for those discontinued treatment was
14.9 months. Factors associated with discontinuation of care included unmarried status (p=0.043), longer driving
distance to facility (p=0.021), and single-modality cancer treatment (p=0.00002). Rurality was not associated with
discontinuation (29.1% vs 22.1% for urban residence, p=0.12), nor was age, gender, or payor status.
Conclusions: Study results indicate that a notable percentage of head and neck cancer survivors discontinue care
with their treating institution. Both demographic and oncologic factors were associated with discontinuation,
pointing to potential interventions. Future research should investigate survivors' follow up patterns after
discontinuation at treating institutions.
Keywords: Survivorship, head and neck neoplasms, discontinuation of care