Barriers to care for childhood cancer survivors at risk for late cardiovascular disease: a mixed methods approach

Purpose Cardiovascular disease (CVD) represents a leading cause of late morbidity and mortality among survivors of childhood cancer. This study aimed to address barriers to longitudinal survivorship-focused care.Methods A previously validated late cardiovascular risk calculator was implemented based on data elements from Passport for Care in a survivorship cohort in Oklahoma. Survivors at moderate and high risk for late CVD were consented and invited to complete a needs assessment survey with knowledge questions on cardiotoxicity. Thematic analysis of interviews with survivors explored barriers to care.Result Among survivors with PFC (n = 477), 71 and 246 were high and moderate risk, respectively. Of the 317 eligible survivors, 80 were contacted and signed electronic consent. Sixty-four percent of participants completed the survey (n = 49; 32 survivors and 17 parents or guardians). Areas of greatest need included improved information delivery and financial concerns. Interviews of survivors (n = 9) revealed themes such as distance to the hospital, transportation, financial hardship, lack of information, and transitions to adult care as significant barriers to longitudinal survivorship-focused care.Conclusion Unaddressed information needs, socioeconomic factors, and geography were significant barriers for survivors. Participants were receptive to telehealth-based interventions.