Health Care of Young Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

TLDR

The study aimed to characterize outpatient care utilization among young adult survivors of childhood cancer and identify factors limiting such care, underscoring the need for improved communication between cancer centers and primary care providers to support risk‑based follow‑up. Using a retrospective cohort of 9,434 survivors (mean age 26.8 yr, 47 % female, 12 % minority, 16 % uninsured), the authors collected baseline questionnaire data and assessed four self‑reported outpatient care outcomes: general contact, physical examination, cancer‑related visit, and cancer‑center visit. Seventy‑seven percent reported general medical contact, 71 % a physical exam, 42 % a cancer‑related visit, and 19 % a cancer‑center visit, with uninsured status, male sex, lack of future‑health concern, and older age reducing likelihood of care, and overall utilization declining with age and time since diagnosis, while primary care physicians provided most care.

Abstract

<b>BACKGROUND</b> We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care. <b>METHODS</b> We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center. <b>RESULTS</b> Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97–2.77), male sex (OR = 1.65; 95% CI, 1.44–1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36–1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35–1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer. <b>CONCLUSIONS</b> Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.