Factors Associated with Adherence to Preventive Care Practices among Hematopoietic Cell Transplantation Survivors

Preventive care guidelines are available for hematopoietic cell transplantation (HCT) survivors. We assessed adherence to these guidelines and examined factors associated with lower adherence. A questionnaire was mailed to adult HCT survivors to collect information regarding survivor health, adherence to recommended guidelines, and financial concerns. Multivariate models identified patient and transplant characteristics associated with lower adherence. Of the 3066 survivors at >2 years after HCT, 1549 (51%) responded. The median age of the respondents was 54.5 years, and the median adherence to recommended preventive care based on age- and sex-specific recommendations was 75%. Lower adherence was associated with autologous HCT, concerns about medical costs, non-white race, male sex, lower physical functioning, absence of chronic graft-versus-host disease, longer time since HCT, and poor knowledge of recommended tests. Although 98% of the respondents had medical insurance, 26% expressed concerns about medical costs and reported efforts to limit medical costs. A concern about medical costs was associated with female sex, age <65 years, absence of chronic graft-versus-host disease, and low physical and mental functional status. Future efforts to improve adherence should address concerns about medical costs and lack of knowledge, two major modifiable predictors of lower adherence to preventive care practices in HCT survivors.