Dental Care for Survivors of Adolescent and Young Adult Cancer: Special Considerations

Abstract

Purpose: Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of adolescent and young adult (AYA) cancer in comparison to individuals without a history of cancer. Methods: The 2008-2012 Medical Expenditure Panel Survey (MEPS) identified 1216 individuals diagnosed with cancer at AYA ages (15-39 years), who were at least 5 years from diagnosis. A comparison group was matched using age, sex, and other factors. We evaluated self-reported dental visits in the previous 12 months , and inability and delay in receiving necessary dental care among survivors and the comparison group. Furthermore, individual factors associated with dental care use were identified using multivariable logistic regressions. Results: Of survivors, 60.86% reported no dental visits in the previous year compared to 51.96% of the comparison individuals ( p < 0.001). Survivors were more likely to report inability (10.71% vs. 6.29%, p = 0.001) and delay (8.12% vs. 4.45%, p = 0.001) in getting necessary dental care than the comparison group. Notably, survivors without dental insurance were more likely to report inability and delay. Female survivors were more likely to use dental care than males (odds ratio = 1.76, 95% confidence interval 1.15-2.71, p = 0.01). Hispanic survivors, those diagnosed at younger ages, and uninsured survivors were less likely to have at least one dental visit. Conclusion: Survivors of AYA cancer need timely surveillance to manage late effects, including dental complications. Yet, these survivors, particularly those who are uninsured, delay dental care more often than individuals from the general population. Survivor-specific interventions are needed to reduce dental care barriers.

Cigarette smoking, comorbidity, and general health among survivors of adolescent and young adult cancer

“…28 A multivariable logistic regression was estimated with 96,042 adults with no history of cancer and 1019 AYA survivors. 29,30 Socioeconomic variables Original Article (eg, insurance) were not included in matching, because they may be affected by cancer exposure. Selection of independent variables was based on the general rule of thumb for matching, which is to include variables that may influence exposure and outcomes and exclude variables that may be affected by exposure.…”

“…The dependent variable in this regression was cancer exposure (1 for survivors and 0 for individuals without a history of cancer), and the independent variables included sex, age at survey, race and ethnicity, census region, and survey year. 30 The predicted values of the regression (ie, the conditional probability of being a cancer survivor) were used as propensity scores. 28 Furthermore, these independent variables have been used in earlier studies for identifying a comparison group for cancer survivors.…”

Health care experiences of long-term survivors of adolescent and young adult cancer

“…A general rule of thumb for selecting independent variables for propensity score estimation is to include variables that may influence exposure and outcomes (access and quality in this study) and exclude variables that may be affected by the exposure [26]. We included sex, age at survey, race and ethnicity, census region, and survey year as independent variables, similar to earlier studies on cancer survivors [21,27]. Please see the section on predictors for the definitions of these variables.…”

Barriers to follow-up care among survivors of adolescent and young adult cancer

“…Despite these guidelines and their risk for developing health problems (i.e., late effects) due to their cancer diagnosis or associated therapy [4, 5], survivors of AYA cancer often forgo routine medical care. Most of the literature on barriers to care for cancer survivors, including those of younger and older survivors, have used closed-ended methods and has focused on cost of medical care [6], access to care [7], and health insurance status [8, 9]. Specific to the AYA cancer population, survivors report greater cost-related barriers to care [7], inability and delay in receiving necessary care (e.g., dental care) [9], and rate the quality of their healthcare lower than individuals from the general population [10].…”