Abstract
Purpose
Adolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored.
Methods
We studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used.
Results
Most AYA cancer survivors (95 %), who were 15–35 months post diagnosis, received medical care in the past 12 months and 17 % were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95 % confidence interval (CI) = 1.7–13.8) or have had health insurance in the past year (OR = 4.0; 95 % CI = 0.99–16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25 % of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys.
Conclusion
AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance.
Implications for Cancer Survivors
Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.
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Acknowledgments
This study was supported by the National Cancer Institute contracts N01-PC-54402, N01-PC-54404, N01-PC-35136, N01-PC-35139, N01-PC-35142, N01-PC-35143, and N01-PC-35145. Dr. Parsons was supported by a National Cancer Institute Cancer Prevention and Control Career Development Award (K07CA175063).
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AYA HOPE Study Collaborative Group is composed of the following: California Cancer Registry/Public Health Institute (Sacramento, CA): Rosemary Cress, Dr. PH (P.I.); Gretchen Agha; and Mark Cruz. Fred Hutchinson Cancer Research Center (Seattle, WA): Stephen M. Schwartz, Ph.D. (P.I.); Martha Shellenberger; and Tiffany Janes. Karmanos Cancer Center (Detroit, MI): Ikuko Kato, M.D., Ph.D. (P.I.); Ann Bankowski; and Marjorie Stock. Louisiana State University (New Orleans, LA): Xiao-cheng Wu, M.D., MPH (P.I.); Vivien Chen; and Bradley Tompkins. Cancer Prevention Institute of California (Fremont, CA): Theresa Keegan, Ph.D., M.S. (P.I.); Laura Allen; Zinnia Loya; and Lisa Shelton-Herendeen. University of Iowa (Iowa City, IA): Charles F. Lynch M.D., Ph.D. (P.I.); Michele M. West; and Lori A. Odle. University of Southern California (Los Angeles, CA): Ann Hamilton, Ph. D (P.I.); Jennifer Zelaya; Mary Lo; and Urduja Trinidad. National Cancer Institute (Bethesda, MD): Linda C. Harlan, BSN, MPH, Ph.D.; (Investigator) Ashley Wilder Smith, Ph.D., MPH (Investigator); Jana Eisenstein; and Gretchen Keel. Consultants: Arnold Potosky, Ph.D.; Keith Bellizzi, Ph.D.; Karen Albritton, MD; Michael Link, MD; and Brad Zebrack, Ph.D.; MSW
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Keegan, T.H.M., Tao, L., DeRouen, M.C. et al. Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?. J Cancer Surviv 8, 282–292 (2014). https://doi.org/10.1007/s11764-013-0332-4
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DOI: https://doi.org/10.1007/s11764-013-0332-4