The Engage program for childhood cancer survivors: Results from a multidisciplinary, distance-delivered intervention.

Abstract

1670 Background: As the growing number of childhood cancer survivors exceeds follow-up care capacity, scalable models to improve access and support self-management are needed. We evaluated the effectiveness of the ‘Engage’ survivorship program (primary outcomes: self-efficacy and health-related quality of life; HRQoL). Methods: Engage is a multidisciplinary program comprising a treatment summary; online health/lifestyle assessment; telehealth nurse consultations; multidisciplinary review; tailored survivorship recommendations for survivors and their nominated primary-care physician. Survivors treated at two Australian hospitals were eligible if diagnosed <18years, >5 years post-diagnosis, and completed treatment. Mixed-effects models examined change over time (baseline, 1-, 6-, 12-month) and differences by diagnosis (brain cancer vs other), adjusting for sex and age at diagnosis. Results: Of 138 consenting survivors 92% completed the health assessment and 89.1% completed the whole program (n=123). Median age was 24 years; median time since diagnosis was 15 years; 28% lived in rural/remote/regional areas; and 53% were brain cancer survivors. Program acceptability was high, with >80% of survivorsreporting Engage was helpful, improved knowledge and confidence, and was easy to access. Health-related self-efficacy improved over 12 months (χ²(3)=146.52, p<.001 ), with no evidence of differences in change between diagnostic groups (time × group; p=.97 ). HRQoL (EQ-5D index) improved modestly by 12 months (0.77 to 0.82; p=.011 ); brain cancer survivors reported lower baseline scores, with similar patterns of change over time. Satisfaction with care improved over time (χ²=35.59, p<.001 ), with higher satisfaction among non-brain cancer survivors (χ²=4.03, p=.045 ) but not over time (time×group p=.75 ). Among health behaviours, alcohol consumption decreased over time (χ²=16.20, p=001) and was higher overall among non-brain survivors (χ²=5.97, p=.015), with no time×group interaction ( p=.94 ). Adherence to personalised healthcare recommendations >50%, with greater adherence if discussed briefly during a follow-up nurse consult. Conclusions: Engage was associated with sustained improvements in survivors’ self-efficacy and satisfaction with care and modest improvements in HRQoL at 12-months follow-up. Similar trajectories across diagnosis groups suggest telehealth survivorship models can also support survivors with higher risk profiles (e.g., brain cancer survivors). Clinical trial information: ACTRN12621000590864.