Hispanic, older young-adult childhood cancer survivors may lack adequate follow-up care
Click Here to Manage Email Alerts
Age and ethnic background appeared associated with inadequate follow-up care among young adult childhood cancer survivors, according to study results published in JNCI Cancer Spectrum.
The Project Forward study — which polled childhood cancer survivors from the Los Angeles County cancer registry, part of the SEER program — showed Hispanic and older survivors were significantly less likely to have received a recent follow-up care visit.
“Prior research has typically focused on nondiverse and hospital-based samples that have limitations (eg, more likely to be in-care). Our study recruited a highly diverse (54% Hispanic/Latino), population-based sample,” Joel Milam, PhD, professor of epidemiology and biostatistics and co-director and co-founder of the Center for Young Adult Cancer Survivorship Research at University of California, Irvine, told Healio.
The final analysis included 1,106 childhood cancer survivors (male, n = 544; mean age at diagnosis, 11.6 years; average years since diagnosis, 14.5) who had been diagnosed with any stage II or greater cancer (stage I or greater for melanoma or brain cancer) by age 19 years between 1996 and 2010 in Los Angeles County. The most common diagnoses included leukemia (36.1%), lymphoma (21.7%) and brain cancer (15.2%).
Participants were at least 5 years removed from their diagnosis and aged between 18 and 39 years when the study launched in 2015. They completed a survey that assessed demographic and clinical factors, as well as health care engagement and psychosocial risk.
Receipt in the prior 2 years of cancer-related follow-up care — defined as any health care visit where a provider completed an examination or tests to evaluate health issues from previous cancer or cancer treatment — served as the study’s primary outcome.
Results showed 57% of the cohort reported a cancer-related follow-up care visit in the prior 2 years.
Adjusted multivariable models showed statistically significant negative associations of follow-up care receipt with Hispanic (adjusted OR [aOR] = 0.69; 95% CI, 0.51-0.95) and other ethnicity (aOR = 0.69; 95% CI, 0.48-0.99) vs. non-Hispanic white, years since diagnosis (aOR = 0.88; 95% CI, 0.84-0.92), and older age at survey completion (31-39 years vs. 18 to 20 years: aOR = 0.35; 95% CI, 0.24-0.5).
Meanwhile, factors significantly associated with receipt of recent care included any vs. no health insurance (aOR = 2.06; 95% CI, 1.28-3.32), two or more late effects vs. no late effects (aOR = 1.54; 95% CI, 1.23-1.92), receipt of a written treatment summary (aOR = 1.47; 95% CI, 1.16-1.87), having a regular doctor for noncancer care (adjusted OR = 1.47; 95% CI, 1.13-1.92), discussion of needed follow-up care with a physician (aOR = 1.95; 95% CI, 1.49-2.55), knowledge of the need for long-term follow-up care (aOR = 3.57; 95% CI, 2.9-4.39) and health care self-efficacy (aOR = 1.23; 95% CI, 1.09-1.39).
“A unique finding was that Hispanic/Latino survivors had lower levels of follow-up care in the fully adjusted models,” Milam told Healio. “We did not identify the reasons for this disparity, but we are currently focused on additional work regarding this.”
The results suggest more work is needed to increase health care engagement as childhood cancer survivors age and to reduce ethnic disparities in access to care, the researchers wrote.
“Obtaining adequate insurance coverage, finding a survivorship clinic if higher risk — or, if lower risk, a primary care physician who has experience with the needs for young cancer survivors — and obtaining a treatment summary and/or survivorship care plan that can be shared/discussed with doctors as needed are all potential suggestions for obtaining/continuing follow-up care,” Milam told Healio.
For more information:
Joel Milam, PhD, can be reached at Department of Medicine, Department of Epidemiology and Biostatistics, Chao Family Comprehensive Cancer Center, University of California, Irvine, 653 E. Peltason Drive, Irvine, CA 92697-7550; email: milamj@hs.uci.edu.
Collapse
Read more about
Click Here to Manage Email Alerts