# Predictors of loss to follow-up after radiotherapy in cancer patients

## TL;DR

This study identifies factors that predict missed follow-up appointments after cancer radiotherapy in Thailand, aiming to improve patient care and outcomes.

## Contribution

The study provides novel insights into predictors of follow-up non-adherence specific to the Thai cancer patient population.

## Key findings

- The loss to follow-up rate was 20% among cancer patients after radiotherapy.
- Distance to hospital and ECOG performance status were significant predictors of missed appointments.
- Common reasons for missed appointments included forgetting, feeling unwell, and hospitalization.

## Abstract

Loss to follow-up after radiotherapy presents a critical challenge in cancer care, undermining treatment effectiveness and efficient use of healthcare resources. Understanding predictors of follow-up non-adherence in the Thai context is essential to improving patient outcomes.

This study aimed to determine the rate, underlying causes, and predictive factors associated with loss to follow-up appointments among cancer patients after completing radiotherapy.

A predictive correlational design was employed with 294 cancer patients who had completed radiotherapy and were scheduled for follow-up appointments. Participants were selected using systematic random sampling. Data were collected through questionnaires, medical record reviews, and telephone interviews for patients who missed appointments. Research instruments included a personal and clinical data form, a radiotherapy service quality assessment based on the SERVQUAL model, and a researcher-developed questionnaire assessing knowledge of follow-up care. Data analysis involved descriptive statistics, chi-square tests, Spearman’s correlation, and multiple logistic regression.

The loss to follow-up rate was 20%. The most common reasons were forgetting appointments (38%), feeling unwell or bedridden (21%), and hospitalization (13%). Multivariate analysis identified two significant predictors: distance from residence to hospital (OR = 1.011, 95% CI 1.003–1.018, p = 0.007) and Eastern Cooperative Oncology Group (ECOG) performance status (OR = 1.973, 95% CI 1.355–2.871, p < 0.001).

Distance to hospital and poorer physical performance status are key predictors of loss to follow-up. Interventions such as telemedicine, multi-channel reminder systems, and case management for high-risk patients are recommended to strengthen continuity of care and reduce missed appointments.