Abstract 6195: Rural and urban disparities in distance to childhood cancer survivorship care
Authors: Amanda S. Thomas, David Van Riper, Jesse Berman, Helen M. Parsons, Lucie Turcotte, Logan Spector, Jenny Poynter, Erin Marcotte
Journal: Cancer Research (2025)

Presently, 1 in 530 young adults (ages 20-39 years) in the US is a survivor of childhood cancer. These individuals are burdened with high risks for chronic disease, disability, secondary cancers, and a shortened lifespan. Because of these late health consequences, survivors are recommended to receive specialized healthcare according to survivorship care guidelines. Despite this, a significant proportion of survivors fail to receive survivorship-directed care, particularly among the adolescent and young adult (AYA) population, suggesting systematic barriers to care. The goal of this analysis was to assess one possible barrier by characterizing where AYA survivors live in the US and their distance to survivorship care centers. The Children’s Oncology Group (COG) Childhood Cancer Research Network (CCRN), a large registry of childhood cancer patients, includes information on cancer diagnosis, place of residence, and initial treatment institution for &amp;gt;50,000 childhood cancer patients treated in North America. In this analysis, CCRN data were linked to LexisNexis via probabilistic matching to derive residential history for each case and up to two parents or guardians and used to evaluate distance to survivorship care. Those with low confidence scores were excluded and the remaining true addresses were geocoded with a 94% good match rate. Distance to care was calculated from the most recent address to nearest COG survivorship center based on those publicly available in the ‘COG Late Effects Directory of Services’ online database. Of individuals of AYA age at diagnosis (15-39 years), 3,396 had successfully geocoded case-specific addresses for survivorship at an average of 14.8 years post-diagnosis (survival time). The most common primary diagnoses were leukemias and lymphomas (54.8%) and mean diagnosis age was 16 years (IQR: 15-18). Nearly 60% were male with 15.8% of Hispanic origin and 74% identifying as White. The most populous states for this cohort (CA, TX, FL, NY) comprised about one-third of all survivors. Average straight-line distance to survivorship care among all AYA survivors was 18.2 miles (IQR: 7.9-45.8), with rural residents having to travel more than four times as far than urban to COG-specific centers. Those that had to travel farther for care were primarily in the low/middle socioeconomic classes (Kruskal-Wallis p-value &amp;lt;0.001) with no considerable differences existing based on sex. Among diagnoses, survivors initially treated for CNS tumors and renal cancer were furthest from survivorship care (average 20.5 and 23.3 miles to nearest COG location, respectively). Treatment at greater distances can become a burden logistically and financially, potentially limiting access to care. As patients transition into survivorship care, distance to care could impact healthcare choices and long-term health outcomes, especially among those with higher-risk initial diagnoses or those from disadvantaged backgrounds. Citation Format: Amanda S. Thomas, David Van Riper, Jesse Berman, Helen M. Parsons, Lucie Turcotte, Logan Spector, Jenny Poynter, Erin Marcotte. Rural and urban disparities in distance to childhood cancer survivorship care [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6195.