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Association of Care Coordination and Discontinuity With Patterns of Care and Outcomes in Childhood Cancer Survivors With Multiple Chronic Conditions: A Report From the Childhood Cancer Survivor Study

Year: 2026

Type: article

Abstract: INTRODUCTION: Given the substantial chronic condition burden among adult survivors of childhood cancer, we explored associations between care coordination and discontinuity with patterns of care and health status. METHODS: Data from Childhood Cancer Survivor Study (CCSS) participants with multiple chronic conditions who completed the validated CC-MC measure of care coordination and discontinuity in 2022 were linked with data from 2019 to 2021 on emergency department [ED] visits, hospitalizations, risk-based survivorship care advice, recommended screenings, and health status (SF-36, Brief Symptom Inventory [BSI-18]). Independent variables included three CC-MC coordination summary scores: main provider (knowing the patient and coordinating their care), multiple provider (coordinating care within and across clinics), patient-provider partnership (explaining things, considering patient goals); and discontinuity (dichotomous). Adjusted generalized linear models estimated prevalence ratios (PR), rate ratios (RR), and beta coefficients. RESULTS: Participants (n = 365) were mean age 48.2 years, 68.5% female, 90.1% non-Hispanic White. Better main provider (RR = 0.87; 95% CI: 0.77-0.99) and multiple provider (RR = 0.85; 95% CI: 0.80-0.90) scores were associated with less ED use; better multiple provider scores with fewer hospitalizations (RR = 0.88; 95% CI: 0.81-0.96); and better patient-provider partnership scores with receiving risk-based survivorship care advice (PR = 1.04; 95% CI: 1.01-1.08). We found no consistent associations between CC-MC scores and recommended screening, though screening rates were generally high. All three CC-MC summary scores were associated with fewer BSI global severity score elevations (PR range: 0.62-0.84). Discontinuity was associated with more hospitalizations (RR = 1.61; 95% CI: 1.03-2.51) and BSI global severity score elevations (PR = 4.20; 95% CI: 1.74-10.16). CONCLUSION: Promoting care coordination across multiple providers and improving continuity may improve care and outcomes in this vulnerable population.

Source: Cancer Medicine

DOI: 10.1002/cam4.72432