Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

Abstract

Objectives. Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer. Data Sources. The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer. Study Design. Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care. Data Collection. There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up. Principal Findings. Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for <high school and high school, respectively) were associated with no care at follow-up. Survivors with severe or life-threatening conditions at baseline (RR 0.5; 95 percent CI 0.3-0.6) were less likely to report no care at follow-up. Conclusions. While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.

Patterns of Loss to Follow-Up Care Among Childhood Cancer Survivors

“…Survivors of childhood cancer are at increased risk for a range of chronic health conditions and late effects related to their malignancy and/or their therapy. [2][3][4][5] It is estimated that 73% of survivors will have at least one chronic health condition 30 years after cancer diagnosis, with survivors 3.3 times more likely to have chronic conditions compared to their siblings and 9 times more likely than their siblings to have a severe or life-threatening condition. 6 Given these findings, specialized follow-up care is essential to survivor's health since follow-up allows for continued surveillance and early diagnosis, rapid intervention, and continued management of late effects.…”

Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions

“…5 Adolescent and young adult (AYA) survivors, a substantial and growing population, 6 demonstrate poor adherence to these recommendations, [7][8][9][10] which is alarming given their increased risk for cancer recurrence, long-term health problems, and poor quality of life. [11][12][13][14][15][16][17][18][19][20] While AYA oncology guidelines stipulate that patients should receive nutrition and exercise guidance, 21 there are limited evidence-based interventions tailored for this group and limited literature on how best to deliver health interventions to AYA survivors. 22 Before designing such interventions, consistent with the Intervention Mapping framework, 23,24 it is important first to identify the barriers to and facilitators of survivors' health behaviors.…”

Pediatric Acute Lymphoblastic Leukemia

“…Finally, Copyright: ©2017 Zwerdling a growing problem for any child treated for cancer whether it is leukemia or other forms, relates to difficulties in finding health care providers after they transition to adult services. Specific programs to facilitate changing from pediatric to adult care models are now in place at larger institutions, but not available everywhere [73,74]. It is known from other long-term follow-up studies that this population will have more medical needs as they age and require care provider's who are able to recognize these and other yet unknown, complications of treatment [70].…”