Predictors of health care utilization in adult survivors of childhood cancer exposed to central nervous system–directed therapy

Abstract

Background Survivors of childhood cancer treated with CNS-directed therapy may be at-risk for poor healthcare utilization due to neurocognitive deficits. This study examined associations between neurocognitive function and adherence to routine and risk-based medical evaluations in adult survivors exposed to CNS-directed therapy. Methods Neurocognitive function and healthcare utilization were assessed in 1304 adult survivors of childhood cancer enrolled in the St. Jude Lifetime Cohort Study. Adherence to recommended care was defined as meeting guidelines published by the Children's Oncology Group. Multivariable models were used to evaluate associations between neurocognitive function and health screenings. Established predictors of healthcare utilization were included as covariates. Odds ratios (OR) or prevalence ratios (PR) and 95% confidence intervals (CIs) were calculated for variables maintained in the final models. Results Adherence to recommended medical care was higher for routine (general physician care: 57.6%; dental care: 49.1%) as opposed to specialized care (survivor-focused care: 21.9%; echocardiogram: 19.9%). Higher intelligence was predictive of general physician care (OR=1.74, 95% CI=1.41 - 2.15) and survivor-focused care (OR=1.44, 95% CI=1.13 – 1.83) compared to no care, while better executive function skills were associated with reduced dental care (PR = 0.94, 95% CI = 0.91-0.98). Echocardiogram monitoring was not associated with neurocognition. Possible late-effects of cancer treatment (pain, reduced cardiorespiratory fitness) were associated with an increased likelihood of receiving specialized medical care. Conclusion Survivors with reduced global cognition are at risk for poor healthcare utilization. Education practices regarding recommended healthcare should be personalized to ensure comprehension by survivors with neurocognitive impairment.

Pain in long‐term survivors of childhood cancer: A systematic review of the current state of knowledge and a call to action from the Children's Oncology Group

“…Quality assessment was completed for each study independently and by considering the following 4 key criteria: 1) selection/subject bias, 2) attrition, 3) instrumentation and missing data, and 4) reporting measurement outcomes (see Supporting Table 2). 3,12‐83 Of the 73 studies reviewed, 36% reported a low risk of bias with respect to selection/subject bias (n = 26 of 73), 1% reported a low risk of bias for attrition (n = 1 of 73), 19% reported a low risk of bias for instrumentation and missing outcomes (n = 14 of 73), and 7% reported a low risk of bias for reporting outcomes (n = 5 of 73). GRADE assessments are provided in Table 1 12,13,15,16,18‐22,24‐26,28,29,31‐34,36,38‐41,44,45,49‐53,60,61,63‐69,71‐73,75,76,78,80,82‐89 …”

Trends in Radiation Therapy among Cancer Survivors in the United States, 2000–2030

“…This indicates a continuing need to manage the long-term effects of radiation therapy in pediatric cancer survivors, including increased risks of secondary malignancy, growth deficiency, and neurocognitive deficits (37). As a result, this growing population will continue with special healthcare needs extending into the foreseeable future (38)(39)(40).…”

Clinical Potential of Transcranial Focused Ultrasound for Neurorehabilitation in Pediatric Cancer Survivors

“…Impairments in intelligence, attention, processing speed, executive function, and cognitive ability are consistently observed and exacerbated by radiation dosage, chemotherapy agents, and time since diagnoses [ 24 , 27 ]. Impaired executive functions—such as working memory, fluency, inhibition, and emotional control—are a compounding risk as they are associated with lower educational attainment, unemployment, and emotional distress [ 28 , 29 ]. Impaired cognition can also manifest detrimental bidirectional relationships between sleep, fatigue, and obesity that worsen over time without effective intervention [ 30 , 31 ].…”