Abstract PR008: The impact of social determinants and neuropsychological factors on healthcare transition readiness among adolescent and young adult childhood cancer survivors
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".