Abstract PR008: The impact of social determinants and neuropsychological factors on healthcare transition readiness among adolescent and young adult childhood cancer survivors
Authors: Gayeong Kim, Jordan Gilleland Marchak, Karen Elizabeth Effinger, Melinda Higgins, Canhua Xiao
Journal: Cancer Research (2024)

Abstract Background: Adolescent and young adult childhood cancer survivors (AYA CCS) reportedly experience at least one severe, disabling, or life-threatening health complication by age 50. Healthcare transition – from pediatric cancer care to adult survivorship care – is vital in ensuring continued follow-up care to screen and manage these complications for this population. This study aimed to examine the impact of neighborhood-level social determinants on healthcare transition readiness among AYA CCS. Additionally, potential mediating and moderating effects of neuropsychological factors such as posttraumatic stress and neurocognitive impairment on the association were also explored. Methods: This study utilized secondary data collected from AYA CCS enrolled in a university-affiliated hospital-based survivorship program. The Readiness for Transition Questionnaire (RTQ) for healthcare transition readiness, the Area Deprivation Index (ADI) for neighborhood social determinants, the Impact of Event Scale-Revised (IESR) for posttraumatic stress, the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) for neurocognitive impairment, and sociodemographic/clinical characteristics (age, sex, race/ethnicity, education, income, insurance, diagnosis, and treatment history and intensity) were included. Mediation and moderated mediation analyses were conducted using Hayes’ bootstrap-based PROCESS Macro with models. Results: Of 113 AYA CCS participants, 54% were female, 71.7% identified as White, and 38.1% were diagnosed with leukemia. AYA CCS residing in more deprived neighborhoods reported higher levels of healthcare transition readiness compared to those in less deprived areas. The average posttraumatic stress level was significantly elevated in more deprived neighborhoods. Neurocognitive impairment was observed in 10.6% of total participants, with no statistical differences in its frequency across ADI quartiles. The mediation analysis showed both significant direct (B = 0.005, SE = 0.002, 95% CI [0.001, 0.009], β = 0.22) and indirect effects (B = 0.001, SE = 0.001, 95% CI [0.0003, 0.0028], β = 0.062) of posttraumatic stress on the relationship between ADI and the RTQ subscale ‘Adolescent Responsibility’, after adjusting for participant’s age, race, diagnosis, and treatment intensity level. There was no mediating effect of posttraumatic stress for other subscales of healthcare transition readiness (‘Parent Involvement’ and ‘Overall Readiness’). The moderated mediation model indicated a significant relationship, with neurocognitive impairment moderating the association between ADI and posttraumatic stress (β = 0.60, SE = 1.17, 95% CI [0.26, 0.95]). Conclusion: The findings suggest that healthcare transition readiness in AYA CCS is influenced by neighborhood-level social determinants and individual neuropsychological factors. Implementing interventions that address these multi-level factors can enhance the transition to adult healthcare for AYA CCS. Citation Format: Gayeong Kim, Jordan Gilleland Marchak, Karen Elizabeth Effinger, Melinda Higgins, Canhua Xiao. The impact of social determinants and neuropsychological factors on healthcare transition readiness among adolescent and young adult childhood cancer survivors [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pediatric Cancer Research; 2024 Sep 5-8; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl):Abstract nr PR008.