Abstract
<title>Abstract</title> <p>Purpose To evaluate whether oncology no-shows were associated with all-cause mortality and whether this association differed by distance to cancer clinic. Methods Retrospective cohort study of adults with cancer who initiated treatment at Essentia Cancer Centers, between 2014–2024 (N = 5793). The outcome was all-cause mortality at last recorded follow-up. The exposure was no-show frequency, categorized as 0, 1 to 2, 3 to 5, and ≥ 6 missed visits. Analyses were conducted using Stata/SE 19.5, with descriptive and inferential models (adjusting for covariates) and significance defined as P≤.05. Results Among 5,793 adults with cancer, median age was 68 (Interquartile Range (IQR), 61–75) years, 3557 (61.4%) were male, and 5488 (94.7%) were non-Hispanic White. Overall, 2492 (43.0%) lived > 20 miles from the clinic, and 2921 (50.4%) were deceased at follow-up. A total of 1967 patients (33.9%) had at least 1 no-show. No-show frequency was 1–2 visits for 1,355 patients (23.4%), 3–5 for 411 (7.1%), and ≥ 6 for 201 (3.5%). In adjusted analysis, 3–5 missed visits were associated with higher odds of mortality compared with no missed visits (Adjusted Odds Ratio (AOR):1.78; 95% CI:1.11–2.86). In distance-stratified models, the association was strongest among patients living > 20 miles from care, where 3–5 missed visits were associated with higher odds of mortality (AOR:2.50; 95% CI:1.23–5.08). Conclusion Missed appointments were common and associated with mortality. Moderate appointment disruption was associated with higher odds of death among patients living > 20 miles from care. Cumulative no-shows may serve as a warning signal for disrupted oncology care.</p>