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
10 affiliations
- 1Johns Hopkins University School of Medicine Baltimore Maryland USA
- 2Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
- 3Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore Maryland USA
- 4UT Southwestern Medical Center Dallas Texas USA
- 5Fred Hutchinson Cancer Center Seattle Washington USA
- 6St. Jude Children's Research Hospital Memphis Tennessee USA
- 7Duke University School of Medicine Durham North Carolina USA
- 8Harvard Medical School Boston Massachusetts USA
- 9Washington University in St. Louis St Louis Missouri USA
- 10Hospital for Sick Children Toronto Ontario Canada
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.
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BibTeX
@article{snyder2026association,
title = {{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}},
author = {Claire Snyder and Rebecca Eary and Wendy M. Leisenring and Kayla L. Stratton and Cynthia M. Boyd and Lorraine T. Dean and Melissa M. Hudson and Eric J. Chow and Kevin C. Oeffinger and Elyse R. Park and Maura M. Kepper and Sara Malone and I‐Chan Huang and Matthew J. Ehrhardt and Vikki Nolan and Gregory T. Armstrong and Paul C. Nathan and Youngjee Choi},
journal = {Cancer Medicine},
year = {2026},
month = nov,
doi = {10.1002/cam4.72432},
url = {https://doi.org/10.1002/cam4.72432},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Claire Snyder
AU - Rebecca Eary
AU - Wendy M. Leisenring
AU - Kayla L. Stratton
AU - Cynthia M. Boyd
AU - Lorraine T. Dean
AU - Melissa M. Hudson
AU - Eric J. Chow
AU - Kevin C. Oeffinger
AU - Elyse R. Park
AU - Maura M. Kepper
AU - Sara Malone
AU - I‐Chan Huang
AU - Matthew J. Ehrhardt
AU - Vikki Nolan
AU - Gregory T. Armstrong
AU - Paul C. Nathan
AU - Youngjee Choi
PY - 2026
DA - 2026/11/03
JO - Cancer Medicine
DO - 10.1002/cam4.72432
UR - https://doi.org/10.1002/cam4.72432
AB - 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.
SN - 2045-7634
ER -