REACH: Reengaging Adolescent and Young Adult Survivors in Cancer-Related Healthcare

Due to advances in treatment, 85% of children survive cancer, resulting in over 242,000 Adolescent and Young Adult (AYA) survivors of childhood cancer in the United States. AYA survivors of childhood cancer, however, face an increased risk of developing new cancers and other chronic illnesses. Despite the greater risk of morbidities and National Cancer Institute (NCI) recommendations for annual long-term follow-up care (LTFU), research has shown that the engagement of AYA survivors in cancer-related follow-up care greatly decreases as they transition out of pediatric healthcare and into adult-focused care.

The lack of engagement of AYA survivors in LTFU care—influenced by socioeconomics, demographics, and knowledge gaps—can lead to delayed and/or poorly managed diagnoses, low awareness of potential health risks, and limited support to enhance self-management (the ability to monitor and manage one’s own health) during the transition to adult healthcare. With existing studies only targeting AYA survivors who are already engaged in LTFU care, disparities are further exacerbated as those who have the most barriers are excluded from interventions.

With R01 funding from National Institute of Health, a project led by PC3I Faculty Lisa Schwartz, PhD is testing multiple intervention strategies to re-engage AYA survivors in healthcare and self-management, ultimately reducing morbidities and health disparities in this population. Schwartz, psychologist at the Children’s Hospital of Philadelphia, and the research team plan to enroll over 400 participants who have not engaged in LTFU care in 15 or more months. Stage 1 of the trial will randomly assign AYA participants into two groups: those who receive a low touch intervention (LTI) of reminder text messages and resources, and those who will receive the standard care of written information in a letter. In Stage 2, patients who made an LTFU appointment after the first intervention will receive the either same intervention or a stepped-up intervention, which is one intervention level higher than the previously administered intervention. On the other hand, patients who did not respond to the first intervention will receive either a stepped-up intervention or a high touch intervention (HTI), which includes digital tools with tailored information to address the individual’s needs, as well as social work and nurse support. Results will be compared to determine the effectiveness of each intervention stage in improving LTFU appointment attendance and self-management ability.

Reengaging Adolescent and Young Adult Survivors in Cancer-Related Healthcare (REACH) is the first trial to specifically target re-engagement of AYA survivors of childhood cancer, offering new insight in addressing barriers to LTFU engagement and promoting self-management. Findings will demonstrate the value and efficacy of digital tools, nudges, and clinician support to re-engage AYA survivors, which is vital to reduce disparities and improve health outcomes among survivors of childhood cancer.

National Cancer Institute R01