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Bolin EH, Ali MM, Farr SL, Oster ME, Klewer SE, Thomas RC, Seckeler MD, Nembhard WN. Health Insurance Status and Access to Healthcare Among Young Adults with Congenital Heart Disease: from the Congenital Heart Survey To Recognize Outcomes, Needs and Well-beinG (CH STRONG), 2016-2019. Pediatr Cardiol 2024; 45:1308-1315. [PMID: 36693998 PMCID: PMC10680444 DOI: 10.1007/s00246-023-03106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
Having health insurance is associated with better access to healthcare and lower rates of comorbidity in the general population, but data are limited on insurance's impact on adults with congenital heart disease (ACHD). The Congenital Heart Survey To Recognize Outcomes, Needs and well-beinG (CH STRONG) was conducted among ACHD in three locations from 2016 to 2019. We performed multivariable logistic regression to determine the associations between health insurance and both access to healthcare and presence of comorbidities. We also compared health insurance and comorbidities among ACHD to similarly-aged individuals in the Behavioral Risk Factor Surveillance System (BRFSS) as a proxy for the general population. Of 1354 CH STRONG respondents, the majority were ≤ 30 years old (83.5%), and 8.8% were uninsured versus 17.7% in the BRFSS (p < 0.01). Compared to insured ACHD, uninsured were less likely to report regular medical care (adjusted odds ratio [aOR] 0.2, 95% confidence interval [CI] 0.1-0.3) and visited an emergency room more often (aOR 1.6, CI 1.0-2.3). Among all ACHD reporting disability, uninsured individuals less frequently received benefits (aOR 0.1, CI 0.0-0.3). Depression was common among uninsured ACHD (22.5%), but insured ACHD had lower rates of depression than insured in the BRFSS (13.3% vs. 22.5%, p < 0.01). In conclusion, rates of insurance were higher among ACHD compared to the general population. Nonetheless, uninsured ACHD inconsistently accessed healthcare and benefits. Further studies are needed to determine if insurance ameliorates the risk of morbidity as ACHD age.
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Affiliation(s)
- Elijah H Bolin
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Box 512-3, Little Rock, AR, 72202, USA.
| | - Mir M Ali
- Institute for Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA, USA
| | - Scott E Klewer
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - R Collins Thomas
- Departments of Pediatrics and Internal Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Michael D Seckeler
- Department of Pediatrics (Cardiology), University of Arizona, Tucson, AZ, USA
| | - Wendy N Nembhard
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Box 512-3, Little Rock, AR, 72202, USA
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, USA
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2
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Smith SM, Teer A, Tolamatl Ariceaga E, Billman E, Benedict C, Goyal A, Pang EM, Pecos-Duarte C, Lewinsohn R, Smith M, Boynton H, Montes S, Rivera E, Ramirez D, Schapira L. A qualitative study of childhood cancer families' post-treatment needs and the impact of a community-based organization in a rural, socioeconomically disadvantaged, majority Hispanic/Latino region. Pediatr Blood Cancer 2024; 71:e30798. [PMID: 38053230 DOI: 10.1002/pbc.30798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individual- and population-level socioeconomic disadvantages contribute to unequal outcomes among childhood cancer survivors. Reducing health disparities requires understanding experiences of survivors from historically marginalized communities, including those with non-English language preference. PROCEDURE We partnered with a community-based organization (CBO) serving families of children with cancer in a rural region in California with low socioeconomic status and majority Hispanic/Latino (H/L) residents. We interviewed English- and Spanish-speaking adolescent/young adult (AYA) childhood cancer survivors (≥15 years old, ≥5 years from diagnosis), parents, and CBO staff to evaluate post-treatment needs and impact of CBO support. Data were analyzed qualitatively using applied thematic analysis. Themes were refined through team discussions with our community partners. RESULTS Twelve AYAs (11 H/L, 11 bilingual), 11 parents (eight H/L, seven non-English preferred), and seven CBO staff (five H/L, five bilingual) participated. AYAs (five female, seven male) were of median (min-max) age 20 (16-32) and 9 (5-19) years post diagnosis; parents (nine female, two male) were age 48 (40-60) and 14 (6-23) years post child's diagnosis. Themes included challenges navigating healthcare, communication barriers among the parent-AYA-clinician triad, and lasting effects of childhood cancer on family dynamics and mental health. Subthemes illustrated that language and rurality may contribute to health disparities. CBO support impacted families by serving as a safety-net, fostering community, and facilitating H/L families' communication. CONCLUSIONS Childhood cancer has long-lasting effects on families, and those with non-English language preference face additional burdens. Community-based support buffers some of the negative effects of childhood cancer and may reduce disparities.
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Affiliation(s)
- Stephanie M Smith
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anmol Teer
- UC Berkeley School of Public Health, Berkeley, California, USA
| | | | - Elle Billman
- Stanford University School of Medicine, Stanford, California, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anju Goyal
- Division of Hematology, Oncology, Stem Cell Transplantation & Regenerative Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily M Pang
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Pecos-Duarte
- Stanford University School of Medicine, Stanford, California, USA
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rebecca Lewinsohn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Smith
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Heidi Boynton
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Sandy Montes
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Esmeralda Rivera
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Daniela Ramirez
- Jacob's Heart Children's Cancer Support Services, Watsonville, California, USA
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Sun R, Sun D, Zhu L, Sun J. Regression analysis of general mixed recurrent event data. LIFETIME DATA ANALYSIS 2023; 29:807-822. [PMID: 37438585 DOI: 10.1007/s10985-023-09604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
In modern biomedical datasets, it is common for recurrent outcomes data to be collected in an incomplete manner. More specifically, information on recurrent events is routinely recorded as a mixture of recurrent event data, panel count data, and panel binary data; we refer to this structure as general mixed recurrent event data. Although the aforementioned data types are individually well-studied, there does not appear to exist an established approach for regression analysis of the three component combination. Often, ad-hoc measures such as imputation or discarding of data are used to homogenize records prior to the analysis, but such measures lead to obvious concerns regarding robustness, loss of efficiency, and other issues. This work proposes a maximum likelihood regression estimation procedure for the combination of general mixed recurrent event data and establishes the asymptotic properties of the proposed estimators. In addition, we generalize the approach to allow for the existence of terminal events, a common complicating feature in recurrent event analysis. Numerical studies and application to the Childhood Cancer Survivor Study suggest that the proposed procedures work well in practical situations.
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Affiliation(s)
- Ryan Sun
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Dayu Sun
- Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Jianguo Sun
- Department of Statistics, University of Missouri, Columbia, MO, USA
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Mobley EM, Moke DJ, Milam J, Ochoa‐Dominguez CY, Stal J, Mitchell H, Aminzadeh N, Bolshakova M, Mailhot Vega RB, Dinalo J, Motala A, Hempel S. Disparities in pediatric cancer survivorship care: A systematic review. Cancer Med 2023; 12:18281-18305. [PMID: 37551113 PMCID: PMC10524017 DOI: 10.1002/cam4.6426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) experience many long-term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access to survivorship care nor receive recommended survivorship care. We reviewed the empirical evidence of disparities in survivorship care for CCS. METHODS This systematic review searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS (PROSPERO: CRD42021227965) and abstracted the reported presence or absence of disparities in care. We screened 7945 citations, and of those, we reviewed 2760 publications at full text. RESULTS A total of 22 studies reported in 61 publications met inclusion criteria. Potential disparities by cancer treatment (N = 14), diagnosis (N = 13), sex (N = 13), and current age (N = 13) were frequently studied. There was high quality of evidence (QOE) of survivorship care disparities associated with non-White race, Hispanic ethnicity, and being uninsured. Moderate QOE demonstrated disparities among CCS who were unemployed and older. Lower QOE was found for disparities based on cancer diagnosis, cancer treatment, age at diagnosis, time since diagnosis, sex, insurance type, income, educational attainment, and geographic area. CONCLUSIONS We found strong empirical evidence of disparities in survivorship care for CCS associated with race, ethnicity, and insurance status. Multiple other disparate groups, such as those by employment, income, insurance type, education, cancer diagnosis, age at diagnosis, time since diagnosis, cancer treatment, geographic area, sex, and self-identified gender warrant further investigation. Prospective, multilevel research is needed to examine the role of other patient characteristics as potential disparities hindering adequate survivorship care in CCS.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Diana J. Moke
- Department of Hematology, Oncology, and Blood and Marrow TransplantationChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
- Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
| | - Joel Milam
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
- Department of Epidemiology and Biostatistics, Program in Public HealthUniversity of California IrvineIrvineCaliforniaUSA
| | - Carol Y. Ochoa‐Dominguez
- Department of Radiation Medicine and Applied Sciences, School of MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Julia Stal
- Southern California Center for Young Adult Cancer Survivorship ResearchLos Angeles and IrvineCaliforniaUSA
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Halle Mitchell
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Naghmeh Aminzadeh
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria Bolshakova
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Raymond B. Mailhot Vega
- Department of Radiation Oncology, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Jennifer Dinalo
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Aneesa Motala
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susanne Hempel
- Southern California Evidence Review Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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Miller KA, Li AA, Wojcik KY, Stal J, Cockburn MG, In GK, Freyer DR, Hamilton AS, Milam JE. Prevalence and correlates of skin examination among ethnically diverse young adult survivors of childhood cancer. Cancer Med 2022; 12:8557-8566. [PMID: 36495004 PMCID: PMC10134373 DOI: 10.1002/cam4.5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Skin cancer is the most common secondary malignancy among young adult childhood cancer survivors (YA-CCS). Skin examination to detect skin cancer early (including melanoma as well as basal or squamous cell skin cancers), both physician-based (PSE) and self-skin exam (SSE), is recommended, particularly for radiotherapy-exposed YA-CCS who are at high risk of developing skin cancer. METHODS Awareness and prevalence of skin examination and demographic, clinical, and healthcare correlates were examined in a population-based sample of YA-CCS with diverse cancer types excluding melanoma. Descriptive frequencies and logistic regression models were conducted using sample weights to correct for non-response bias with PSE, SSE and adherence to both as outcomes. RESULTS The sample comprised 1064 participants with 53% Latino. Eight percent of participants were aware of the need for skin examination; 9% reported receipt of PSE within past 2 years; 35% reported regular SSE; and 6% were adherent to both. Among the radiotherapy-treated, 10% were aware of the need for skin examination, 10% reported recent PSE; 38% reported regular SSE; and 8% were adherent to both. Healthcare and clinical factors including healthcare self-efficacy, engagement in cancer-related follow-up care, greater treatment intensity and greater number of treatment-related late effects were positively associated with PSE and SSE. Latino YA-CCS were less likely to engage in PSE and SSE. CONCLUSION(S) Adherence to recommended screening for skin cancer was low in this at-risk population, notably for YA-CCS exposed to radiotherapy. The development of effective strategies to expand skin cancer screening is needed in this at-risk population.
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Affiliation(s)
- Kimberly A. Miller
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Angela A. Li
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Katherine Y. Wojcik
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Julia Stal
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Myles G. Cockburn
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California Los Angeles California USA
| | - Gino K. In
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Medicine Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
| | - David R. Freyer
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles Los Angeles California USA
- Department of Pediatrics Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Chao Family Comprehensive Cancer Center University of California Irvine California USA
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6
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Larson AE, Angier H, Suchocki A, Voss RW, Marino M, Warren N, Huguet N. Primary and mental health service use in community health center patients before and after cancer diagnosis. Cancer Med 2022; 11:2320-2328. [PMID: 35481624 PMCID: PMC9160808 DOI: 10.1002/cam4.4524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cancer survivors face increased risk for chronic diseases resulting from cancer, preexisting conditions, and cancer treatment. Having an established primary care clinic or health insurance may influence patients' receipt of recommended preventive care necessary to manage, treat, or diagnose new conditions. This study sought to understand receipt of healthcare in community health centers (CHCs) before and after cancer diagnosis among cancer survivors. We also examined the type of care received and assessed whether being established with a CHC or the type of health insurance affected the use of services. METHODS Using electronic health record data and linked cancer registries from 5,649 CHC patients in three states from 2012 through 2018, we obtained monthly rates of primary care and mental health/behavioral health (MHBH) visits and the probability of receipt of care before and after a cancer diagnosis. RESULTS Seventy-five percent of CHC patients diagnosed with cancer returned to their primary CHC for care within 2-years of their diagnosis. Among those who returned, there was a sharp increase in primary and MHBH care shortly before their diagnosis. Significantly more primary care (pre: 19.6%, post: 21.9%, p < 0.001) and MHBH care (pre: 1.2%, post: 1.6%, p < 0.001) was received after diagnosis than before. However, uninsured patients had fewer visits after their diagnosis than before. CONCLUSION Use of preventive care for cancer survivors is particularly important. Having an established primary care clinic may help to ensure survivors receive recommended screening and care.
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Affiliation(s)
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Robert W Voss
- Research Department, OCHIN Inc., Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.,Biostatistics Group, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Mobley EM, Kim SE, Cousineau M, Tsui J, Miller KA, Tobin J, Freyer DR, Milam JE. Insurance coverage change and survivorship care among young adult survivors of childhood cancer. Health Serv Res 2022; 57:159-171. [PMID: 34378205 PMCID: PMC8763279 DOI: 10.1111/1475-6773.13868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To (1) characterize change in type of insurance coverage among childhood cancer survivors from diagnosis to survivorship and (2) examine whether insurance change is associated with cancer-related follow-up care utilization. DATA SOURCES Participants in this study were derived from the Project Forward study, a population-based, observational study of childhood cancer survivors in Los Angeles County that used California Cancer Registry data to identify participants. STUDY DESIGN Multivariable logistic regression models incorporating survey nonresponse weights estimated the change in the marginal predicted probabilities of insurance change and survivorship care, adjusting for demographic, socioeconomic, and clinical covariates and clustering by treating hospital. DATA COLLECTION/EXTRACTION METHODS Study participants were diagnosed with cancer who were younger than age 20 years while living in Los Angeles County from 1996 to 2010 and were older than the age 18 years at the time of survey participation, from 2015 to 2017 (N = 1106). PRINCIPAL FINDINGS Most participants were 18-26 years of age, male, diagnosed before 2004, Hispanic/Latino race/ethnicity, single, without children, highly educated, not employed full time, and lived with their parents at survey. Almost half (N = 529) of participants experienced insurance change from diagnosis to survivorship. Insurance change was associated with insurance coverage at diagnosis, as those who were uninsured were most likely to experience change and gain coverage during survivorship (by 51 percentage points [ppt], standard error [SE] of 0.05). Survivors who experienced any change had decreased probability of reporting a recent cancer-related follow-up care visit, a disparity that was magnified for those who lost insurance coverage (-5 ppt, SE 0.02 for those who gained coverage; -15 ppt, SE 0.04 for those who lost coverage). CONCLUSIONS Insurance coverage change was associated with lower cancer-related follow-up care utilization. Indeed, survivors who experienced any insurance coverage change had decreased probability of having a cancer-related follow-up care visit, and this was magnified for those who lost their insurance coverage.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | - Sue E. Kim
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michael Cousineau
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jennifer Tsui
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Kimberly A. Miller
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Department of DermatologyKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jessica Tobin
- VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - David R. Freyer
- Department of Preventive MedicineKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA,Children's Hospital Los AngelesLos AngelesCaliforniaUSA,USC Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, School of MedicineChao Family Comprehensive Cancer Center, University of CaliforniaIrvineCaliforniaUSA
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8
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Rodriguez-Hernandez A, Kahn JM. Improving Health Equity and Reducing Pediatric Cancer Disparities: The Role of the Medical Home. Pediatr Ann 2022; 51:e22-e26. [PMID: 35020511 DOI: 10.3928/19382359-20211207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The advances in pediatric cancer outcomes over the last quarter century are some of the most successful in modern medicine. Improved diagnostics and novel therapies have led to continued increases in the survival rates of most patients; however, not all populations have benefitted equally. Compared to White children, Black, Indigenous, People of Color patients with cancer more often present with advanced stage illness, less frequently participate in clinical trials, and are more likely to be lost to follow-up once therapy is complete. Proposed hypotheses for these disparities include both biologic and nonbiologic factors, and a growing body of research suggests that barriers influencing care from diagnosis through survivorship are important. In this article, we consider how primary pediatricians can help reduce disparities over the cancer continuum by identifying vulnerable populations, considering potential diagnoses, referring to cancer centers, and following up with patients through survivorship in partnership with the oncology team. [Pediatr Ann. 2022;51(1):e22-e26.].
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9
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Fiala MA. Disparities in health care affordability among childhood cancer survivors persist following the Affordable Care Act. Pediatr Blood Cancer 2021; 68:e29370. [PMID: 34626446 DOI: 10.1002/pbc.29370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) included many provisions that may have improved access to care for childhood cancer survivors (CCS). In this study, we sought to compare health insurance coverage and the affordability of health care among adult childhood CCS before and after the implementation of the ACA. PROCEDURE Using data from the National Health Interview Survey (NHIS), two cohorts of CCS age 21-65 years old and matched (1:3) controls without a history of cancer were identified. A difference-in-differences analysis was used to compare insurance coverage and health care affordability pre- (2011-2013) and post-ACA (2015-2017). RESULTS There were 309 CCS identified in the pre-ACA cohort and 324 in the post-ACA cohort. The two cohorts were similar in demographic composition. Prior to the ACA, CCS were 39% more likely to be uninsured than their peers (p = .046). Post, there was no difference in the odds of being uninsured between CCS and their peers. Following implementation of the ACA, the proportion of CCS who reported having difficulty with the affordability of health care decreased (p = .013) as did the proportion reporting skipping needed care due to cost (p < .001). However, 13% of CCS still reported being uninsured, 36% reported difficulty paying for health care, and 13% reported foregoing needed care due to cost. Relative to their peers, CCS saw improvement in foregoing needed care due to cost, but disparities still remain. CONCLUSIONS Although improvements were observed, health care affordability, and medical nonadherence remains a problem for CCS. IMPLICATIONS FOR CANCER SURVIVORS Additional efforts are needed to improve health care affordability among CCS.
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Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, Missouri, USA.,School of Social Work, Saint Louis University, St Louis, Missouri, USA
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10
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Kagramanov D, Sutradhar R, Lau C, Yao Z, Pole JD, Baxter NN, Gupta S, Nathan PC. Impact of the model of long-term follow-up care on adherence to guideline-recommended surveillance among survivors of adolescent and young adult cancers. Cancer Med 2021; 10:5078-5087. [PMID: 34128353 PMCID: PMC8335842 DOI: 10.1002/cam4.4058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Adolescent and young adult cancer survivors require lifelong healthcare to address the late effects of therapy. We examined the impact of different provider models of long-term follow-up (LTFU) care on adherence to recommended surveillance. METHODS We conducted a retrospective cohort study using administrative health databases in Ontario, Canada. Five-year survivors were identified from IMPACT, a database of patients aged 15-20.9 years at diagnosis of six cancers between 1992 and 2010. We defined three models of LTFU care hierarchically: specialized survivor clinics (SCCs), general cancer clinics (GCCs), and family physician (FP). We assessed adherence to the Children's Oncology Group surveillance guidelines for cardiomyopathy and breast cancer. Multistate models assessed adherence transitions and impacts of LTFU attendance. RESULTS A total of 1574 survivors were followed for a mean of 9.2 years (range 4.3-13.9 years) from index (5-year survival). The highest level of LTFU attended in the first 2-years post-index was a GCC (47%); only 16.7% attended a SCC. By the end of study, 72% no longer attended any of the models of care and only 2% still attended an SCC. Among 188 survivors requiring breast cancer surveillance, 6.9% were adherent to their first required surveillance testing. Attendance at a SCC in the previous year and higher cumulative FP or GCC visits increased the rate of subsequently becoming adherent. Among 857 survivors requiring cardiomyopathy surveillance, 11% were adherent at study entry. Each subsequent SCC visit led to an 11.3% (95% CI: 1.05-1.18) increase in the rate of becoming adherent. CONCLUSION LTFU attendance and surveillance adherence are sub-optimal. SCC follow-up is associated with greater adherence, but few survivors receive such care, and this proportion diminished over time. Interventions are needed to improve LTFU attendance and promote surveillance adherence.
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Affiliation(s)
- Dalia Kagramanov
- University of Toronto, Institute of Medical Science, Toronto, Canada
| | - Rinku Sutradhar
- University of Toronto, Institue of Health Policy, Management and Evaluation, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Cindy Lau
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Zhan Yao
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jason D Pole
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Nancy N Baxter
- University of Toronto, Institue of Health Policy, Management and Evaluation, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Keenan Research Center of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.,University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Sumit Gupta
- University of Toronto, Institute of Medical Science, Toronto, Canada.,University of Toronto, Institue of Health Policy, Management and Evaluation, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,ICES, Toronto, Canada
| | - Paul C Nathan
- University of Toronto, Institute of Medical Science, Toronto, Canada.,University of Toronto, Institue of Health Policy, Management and Evaluation, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,ICES, Toronto, Canada
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11
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Baedke JL, Lindsey LA, James AS, Huang IC, Ness KK, Howell CR, Brinkman TM, Bhakta N, Ehrhardt MJ, Im C, Letsou W, Liu Q, Robison LL, Hudson MM, Yasui Y. Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities. J Cancer Surviv 2021; 16:677-687. [PMID: 34046821 PMCID: PMC8626536 DOI: 10.1007/s11764-021-01061-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate racial/ethnic-related disparities by insurance status in "forgoing needed medical care in the last year due to finances" in childhood cancer survivors. METHODS Our study included 3310 non-Hispanic/Latinx White, 562 non-Hispanic/Latinx Black, and 92 Hispanic/Latinx survivors from the St. Jude Lifetime Cohort Study. Logistic regression analyses, guided by Andersen's Healthcare Utilization Model, were adjusted for "predisposing" (survey age, sex, childhood cancer diagnosis and treatment, and treatment era) and "need" (perceived health status) factors. Additional adjustment for household income/education and chronic health conditions was considered. RESULTS Risk of forgoing care was highest among non-Hispanic/Latinx Blacks and lowest among Hispanics/Latinxs for each insurance status. Among privately insured survivors, relative to non-Hispanic/Latinx Whites, non-Hispanic/Latinx Blacks were more likely to forgo care (adjusted OR: 1.82, 95% CI: 1.30-2.54): this disparity remained despite additional adjustment for household income/education (adjusted OR: 1.43, 95% CI: 1.01-2.01). In contrast, publicly insured survivors, regardless of race/ethnicity, had similar risk of forgoing care as privately insured non-Hispanic/Latinx Whites. All uninsured survivors had high risk of forgoing care. Additional chronic health condition adjustment did not alter these results. CONCLUSIONS Provision of public insurance to all childhood cancer survivors may diminish racial/ethnic disparities in forgoing care that exist among the privately insured and reduce the risk of forgoing care among uninsured survivors to that of privately insured non-Hispanic/Latinx Whites. IMPLICATIONS FOR CANCER SURVIVORS Under public insurance, childhood cancer survivors had low risk of forgoing care, at the similar level to privately insured non-Hispanic/Latinx Whites, regardless of race/ethnicity.
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Affiliation(s)
- Jessica L Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Lauren A Lindsey
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Aimee S James
- Department of Surgery, Washington University School of Medicine, Campus Box 8109, 4590 Children's Place, Suite 9600, St. Louis, MO, 63110, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Medical Towers, MT-621, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Psychology, St. Jude Children's Research Hospital, Mailstop 740, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Mailstop 721, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Cindy Im
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - William Letsou
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Qi Liu
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA
- Department of Oncology, St. Jude Children's Research Hospital, Mailstop 260, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Mailstop 735, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
- School of Public Health, University of Alberta: Edmonton Clinic Health Academy, Room 3-300, 11405 87th Avenue, Edmonton, Alberta, T6G 1C9, Canada.
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12
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Chan CWH, Choi KC, Chien WT, Sit JWH, Wong R, Cheng KKF, Li CK, Yuen HL, Li CK. Health Behaviors of Chinese Childhood Cancer Survivors: A Comparison Study with Their Siblings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176136. [PMID: 32846965 PMCID: PMC7503484 DOI: 10.3390/ijerph17176136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Purpose: This study aimed to compare health behaviors between the childhood cancer survivors (CCS) and their sibling controls and to examine the pattern of health behaviors of the Hong Kong Chinese CCS and its associations with their health-related quality of life and psychological distress. Methods: A cross-sectional telephone survey was conducted. A total of 614 CCS and 208 sibling controls participated in this study. Patterns of health behaviors including lifestyle behaviors, cancer screening practices, and insurance coverage were compared. Multivariate regression analyses were performed for examining factors associated with health behaviors in CCS. Results: CCS had less alcohol consumption when compared with their sibling controls (adjusted odds ratio (AOR) = 0.65, p = 0.035). The sibling controls were more likely to have cancer screening practices (AOR = 0.38, p = 0.005) and health (AOR = 0.27, p < 0.001) and life insurance coverage (AOR = 0.38, p < 0.001). Among the CCS, those who were male, having a job or higher education, shorter time since diagnosis, and type of cancer suffered were significantly associated with alcohol consumption. Those CCS who were drinkers indicated poorer mental health (p = 0.004) and more psychological distress. Female CCS undertaking cancer screening were more likely to be employed, married/cohabiting, and have received intensive cancer treatment. Conclusion: This study reveals that Chinese childhood cancer survivors are less likely to engage in unhealthy lifestyle behaviors, insurance coverage and cancer screening, when compared with their siblings. Implications for Cancer Survivors: It is crucial for healthcare professionals to identify strategies or target interventions for raising CCS's awareness of their cancer risks and healthy lifestyle throughout their life.
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Affiliation(s)
- Carmen W. H. Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (W.T.C.); (J.W.H.S.)
- Correspondence: ; Tel.: +852-3943-6218
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (W.T.C.); (J.W.H.S.)
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (W.T.C.); (J.W.H.S.)
| | - Janet W. H. Sit
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China; (K.C.C.); (W.T.C.); (J.W.H.S.)
| | - Rosa Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China;
| | - Karis K. F. Cheng
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore 119077, Singapore;
| | - Chi Kong Li
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China;
| | - Hui Leung Yuen
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China;
| | - Chi Keung Li
- Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China;
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13
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Clinical Trial Enrollment is Associated With Improved Follow-up Rates Among Survivors of Childhood Cancer. J Pediatr Hematol Oncol 2019; 41:e18-e23. [PMID: 29668542 PMCID: PMC6854689 DOI: 10.1097/mph.0000000000001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fortunately >80% of children diagnosed with cancer become long-term survivors; however, this population is at a significantly increased risk of morbidity and mortality as a result of their previous cancer therapy, and long-term follow-up (LTFU) is critical. Multiple barriers to receiving adequate LTFU care have been studied. We investigated whether lack of enrollment in a therapeutic clinical trial may be a barrier to receiving LTFU care. We conducted a review of 353 patient records at the Children's Hospital of Michigan enrolled in our Children's Oncology Group registry between January 1, 2005 and December 31, 2010. In total, 71 patients were excluded (death before follow-up, n=61; currently receiving therapy, n=5; known transfer of care, n=4; insufficient information, n=1). In total, 158 (56%) patients were enrolled in a therapeutic clinical trial. Follow-up rates at 1-, 2- and 5-years following completion of therapy for patients enrolled in a therapeutic clinical trial were 96.8% (153/158), 93.7% (148/158), and 81.7% (103/126), respectively, compared with 83.1% (103/124; P<0.001), 74.2% (92/124; P<0.001), and 66.7% (72/108; P=0.001) for patients not enrolled. Our findings suggest patients enrolled in a therapeutic clinical trial have better LTFU rates and supports the importance of patient enrollment in therapeutic clinical trials when possible. Additional resources may be warranted to improve LTFU for patients not enrolled.
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14
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Cousineau MR, Kim SE, Hamilton AS, Miller KA, Milam J. Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958018817996. [PMID: 30791853 PMCID: PMC6362514 DOI: 10.1177/0046958018817996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 11/08/2018] [Accepted: 11/16/2018] [Indexed: 01/07/2023]
Abstract
The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents' regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancer specialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen a primary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). In addition, those with public (vs private) insurance were less likely to have a regular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likely to have made a primary care visit in the past year (OR = 2.8, 95% CI = 2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, and those with public (vs. private) insurance have less access to primary care. Policies that ensure continuity of coverage for survivors as they age into adulthood may result in fewer barriers to needed care, which may lead to fewer health problems for CCS in the future.
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Affiliation(s)
| | - Sue E. Kim
- Keck School of Medicine of USC, Los
Angeles, USA
| | | | | | - Joel Milam
- Keck School of Medicine of USC, Los
Angeles, USA
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15
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Daly A, Lewis RW, Vangile K, Masker KW, Effinger KE, Meacham LR, Mertens AC. Survivor clinic attendance among pediatric- and adolescent-aged survivors of childhood cancer. J Cancer Surviv 2018; 13:56-65. [PMID: 30560348 DOI: 10.1007/s11764-018-0727-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Childhood cancer survivors need regular, risk-adapted, long-term survivor care. This retrospective study describes the proportion of survivors seen for an initial survivor clinic visit within a large pediatric oncology program. METHODS Patients diagnosed with non-central nervous system childhood malignancies from 2007 to 2012 were followed from the time of survivor clinic eligibility (2 years following completion of therapy) through their initial survivor clinic visit or end of study. Demographic, cancer-related, and logistical factors related to clinic attendance were examined using Kaplan-Meier curves and Cox proportional regressions. RESULTS Eligible survivors were 53.0% male, 51.5% non-Hispanic white, and 30.9% survivors of leukemia. Among the 866 eligible survivors for this study, 610 (70.4%) completed their initial visit. After controlling for sex and time eligible, survivors who received surgery only (aHR 0.04 (0.02, 0.08)) or radiation only (0.24 (0.15, 0.39)) and who had Medicaid (0.77 (0.64, 0.92)) were significantly less likely to have an initial visit as were those of black or other/mixed race and those who lived > 25 mi from the clinic (p < 0.01). Survivors aged 6-11 years or 12-17 years at eligibility were significantly more likely to complete an initial visit as compared to those aged 2-5 years (1.55 (1.24, 1.93) and 1.44 (1.14, 1.83), respectively). CONCLUSIONS Nearly a third of survivors were not seen in a pediatric survivor clinic despite the importance of survivor care. These results identify populations at risk for not pursuing long-term survivorship care. IMPLICATIONS FOR CANCER SURVIVORS Failure to transition to pediatric survivor care may lead to lifelong non-engagement and incorrect perceptions about future health.
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Affiliation(s)
- Ashley Daly
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Division of Behavioral Health, Idaho Department of Health and Welfare, Boise, ID, USA
| | | | - Kristen Vangile
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Karen Wasilewski Masker
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Karen E Effinger
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Lillian R Meacham
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA
| | - Ann C Mertens
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, 4th Floor, Atlanta, GA, 30322, USA.
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16
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Staba Hogan MJ, Ross WL, Balsamo L, Mitchell HR, Kadan-Lottick NS. Parental perception of child vulnerability in childhood cancer survivors. Pediatr Blood Cancer 2018; 65:e27364. [PMID: 30024087 DOI: 10.1002/pbc.27364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/08/2018] [Accepted: 06/23/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents' perception of their children's vulnerability to illness following cancer treatment is largely unknown, but is important to understand given known challenges of transitioning survivors to postcancer care. We investigated the frequency of and factors associated with perceived vulnerability by parents of childhood cancer survivors attending a regional survivorship clinic. PROCEDURE This cohort study was offered to all parents of pediatric patients (currently ≤18 years) attending the Yale childhood cancer survivorship clinic January 2010 to October 2016 who were ≥1 year postcurative cancer therapy. Participating parents (one per patient) completed the standardized Child Vulnerability Scale at the beginning of the clinic visit (cutoff score ≥10 for perceived vulnerability). Patient sociodemographics, cancer history, and posttherapy complications were abstracted from medical records. RESULTS Overall, 116 parents participated (98% participation rate) consisting of 89% mothers; survivors were 46% female, had a current mean age of 12.7 ± 3.9 years, and were a mean of 6.4 ± 3.8 years posttherapy. Twenty-eight percent (n = 33) of parents perceived their children as vulnerable. Survivor sociodemographics (age, sex, race/ethnicity, family income, insurance, parental marital status, number of siblings), cancer diagnosis, years off-therapy, survivorship visit number, treatment intensity, and late complications (number, type, severity) were not associated with perception of vulnerability. CONCLUSIONS A sizeable proportion of parents continue to perceive their children as vulnerable even years after cancer therapy completion independent of current health status or past cancer history. Our data suggest the need to educate all parents of childhood cancer survivors regarding health risk, including those at lower risk for late complications.
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Affiliation(s)
- Mary-Jane Staba Hogan
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Wilhelmenia L Ross
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Lyn Balsamo
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | | | - Nina S Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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17
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Nathan PC, Henderson TO, Kirchhoff AC, Park ER, Yabroff KR. Financial Hardship and the Economic Effect of Childhood Cancer Survivorship. J Clin Oncol 2018; 36:2198-2205. [DOI: 10.1200/jco.2017.76.4431] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In addition to the long-term physical and psychological sequelae of cancer therapy, adult survivors of childhood cancer are at an elevated risk for financial hardship. Financial hardship can have material, psychological, and behavioral effects, including high out-of-pocket medical costs, asset depletion and debt, limitations in or inability to work, job lock, elevated stress and worry, and a delaying or forgoing of medical care because of cost. Most financial hardship research has been conducted in survivors of adult cancers. The few studies focused on childhood cancer survivors have shown that these individuals are at elevated risk for having difficulties with affording needed health care and report high out-of-pocket medical expenses, difficulty with paying medical bills, or consideration of filing for bankruptcy. Childhood cancer survivors are more likely to be unable to work or to have missed work because of poor health. They are more likely to report difficulties with obtaining insurance coverage and rely more frequently on government-sponsored insurance. Globally, countries able to provide curative cancer therapies have witnessed a growing population of survivors, which places a burden on their health care systems because survivors are more likely to require hospitalization and experience a higher burden of chronic illness than the general population. Guidelines for surveillance for late effects are intended to reduce the burden of morbidity, but research is needed to determine whether such surveillance is cost effective. Of note, risk-based survivor care should include routine surveillance for financial hardship. Improved measures of financial hardship, enhanced data infrastructure, and research studies to identify survivors and families most vulnerable to financial hardship and adverse health outcomes will inform the development of targeted programs to serve as a safety net for those at greatest risk.
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Affiliation(s)
- Paul C. Nathan
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Tara O. Henderson
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Anne C. Kirchhoff
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - Elyse R. Park
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
| | - K. Robin Yabroff
- Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA
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18
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Brinkman TM, Recklitis CJ, Michel G, Grootenhuis MA, Klosky JL. Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature. J Clin Oncol 2018; 36:2190-2197. [PMID: 29874134 PMCID: PMC6053297 DOI: 10.1200/jco.2017.76.5552] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The diagnosis, treatment, and medical late effects of childhood cancer may alter the psychosocial trajectory of survivors across their life course. This review of the literature focuses on mental health symptoms, achievement of social milestones, socioeconomic attainment, and risky health behaviors in survivors of childhood cancer. Results suggest that although most survivors are psychologically well adjusted, survivors are at risk for anxiety and depression compared with siblings. Although the absolute risk of suicide ideation and post-traumatic stress symptoms is low, adult survivors are at increased risk compared with controls. Moreover, young adult survivors are at risk for delayed psychosexual development, lower rates of marriage or cohabitation, and nonindependent living. Survivors' socioeconomic attainment also is reduced, with fewer survivors graduating college and gaining full-time employment. Despite risk for late health-related complications, survivors of childhood cancer generally engage in risky health behaviors at rates similar to or only slightly lower than siblings and peers. CNS tumors and CNS-directed therapies are salient risk factors for poor psychosocial outcomes. In addition, physical health morbidities resulting from cancer-directed therapies are associated with worse psychosocial functioning. Several studies support the effectiveness of cognitive and behavioral interventions to treat psychological symptoms as well as to modify health behaviors. Additional randomized controlled trials are needed to evaluate the efficacy and long-term outcomes of intervention efforts. Future research should focus on the identification of potential genetic predispositions related to psychosocial outcomes to provide opportunities for preventive interventions among survivors of childhood cancer.
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Affiliation(s)
- Tara M Brinkman
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Christopher J Recklitis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gisela Michel
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Martha A Grootenhuis
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - James L Klosky
- Tara M. Brinkman and James L. Klosky, St Jude Children's Research Hospital, Memphis, TN; Christopher J. Recklitis, Dana-Farber Cancer Institute, Boston, MA; Gisela Michel, University of Lucerne, Lucerne, Switzerland; and Martha A. Grootenhuis, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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19
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Mueller EL, Park ER, Kirchhoff AC, Kuhlthau K, Nathan PC, Perez GK, Rabin J, Hutchinson R, Oeffinger KC, Robison LL, Armstrong GT, Leisenring WM, Donelan K. Insurance, chronic health conditions, and utilization of primary and specialty outpatient services: a Childhood Cancer Survivor Study report. J Cancer Surviv 2018; 12:639-646. [PMID: 29943170 DOI: 10.1007/s11764-018-0700-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/23/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors' utilization of outpatient healthcare provider services. METHODS The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. RESULTS Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2-62.6), median time from diagnosis 28.8 years (range 23.1-41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician's assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95% CI 2.89-9.17) or a survivorship clinic (OR = 2.93, 95% CI 1.18-7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95% CI 1.37-5.58; public, OR = 2.09, 95% CI 0.85-5.11), PCP (private, OR = 7.82, 95% CI 3.80-13.10; public, OR = 7.24, 95% CI 2.75-19.05), and specialty care (private, OR = 2.96, 95% CI 1.48-5.94; public, OR = 2.93, 95% CI 1.26-6.84) compared to without insurance. CONCLUSION Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. IMPLICATIONS FOR CANCER SURVIVORS Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.
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Affiliation(s)
- Emily L Mueller
- Indiana University, 410 West 10th Street, Suite 2000A, Indianapolis, IN, 46202, USA.
| | | | | | | | - Paul C Nathan
- The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Julia Rabin
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
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Dixon SB, Bjornard KL, Alberts NM, Armstrong GT, Brinkman TM, Chemaitilly W, Ehrhardt MJ, Fernandez-Pineda I, Force LM, Gibson TM, Green DM, Howell CR, Kaste SC, Kirchhoff A, Klosky JL, Krull KR, Lucas JT, Mulrooney DA, Ness KK, Wilson CL, Yasui Y, Robison LL, Hudson MM. Factors influencing risk-based care of the childhood cancer survivor in the 21st century. CA Cancer J Clin 2018; 68:133-152. [PMID: 29377070 PMCID: PMC8893118 DOI: 10.3322/caac.21445] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/30/2022] Open
Abstract
The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient-specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment-related toxicity and possible targets for intervention in this population. Furthermore, although current long-term follow-up guidelines comprehensively address specific therapy-related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment-related health risk and evolving treatment approaches, a patient-centered and risk-adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133-152. © 2018 American Cancer Society.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kari L Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Wassim Chemaitilly
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Pediatric Medicine – Division of Endocrinology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Matthew J Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Lisa M Force
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel M Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carrie R Howell
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sue C Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN
| | - Anne Kirchhoff
- Department of Pediatrics and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - James L Klosky
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kevin R Krull
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Daniel A Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Carmen L Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Tai E, Hallisey E, Peipins LA, Flanagan B, Lunsford NB, Wilt G, Graham S. Geographic Access to Cancer Care and Mortality Among Adolescents. J Adolesc Young Adult Oncol 2018; 7:22-29. [PMID: 28933979 PMCID: PMC6125785 DOI: 10.1089/jayao.2017.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Adolescents with cancer have had less improvement in survival than other populations in the United States. This may be due, in part, to adolescents not receiving treatment at Children's Oncology Group (COG) institutions, which have been shown to increase survival for some cancers. The objective of this ecologic study was to examine geographic distance to COG institutions and adolescent cancer mortality. METHODS We calculated cancer mortality among adolescents and sociodemographic and healthcare access factors in four geographic zones at selected distances surrounding COG facilities: Zone A (area within 10 miles of any COG institution), Zones B and C (concentric rings with distances from a COG institution of >10-25 miles and >25-50 miles, respectively), and Zone D (area outside of 50 miles). RESULTS The adolescent cancer death rate was highest in Zone A at 3.21 deaths/100,000, followed by Zone B at 3.05 deaths/100,000, Zone C at 2.94 deaths/100,000, and Zone D at 2.88 deaths/100,000. The United States-wide death rate for whites without Hispanic ethnicity, blacks without Hispanic ethnicity, and persons with Hispanic ethnicity was 2.96 deaths/100,000, 3.10 deaths/100,000, and 3.26 deaths/100,000, respectively. Zone A had high levels of poverty (15%), no health insurance coverage (16%), and no vehicle access (16%). CONCLUSIONS Geographic access to COG institutions, as measured by distance alone, played no evident role in death rate differences across zones. Among adolescents, socioeconomic factors, such as poverty and health insurance coverage, may have a greater impact on cancer mortality than geographic distance to COG institution.
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Affiliation(s)
- Eric Tai
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elaine Hallisey
- Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucy A. Peipins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barry Flanagan
- Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha Buchanan Lunsford
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grete Wilt
- Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shannon Graham
- Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Despite the increase in thyroid cancer incidence among adolescents and young adults (AYAs), this group has received limited attention. We reviewed the epidemiology and challenges of thyroid cancer care among AYAs, and proposed a research agenda to improve their care. Thyroid cancer is the most common cancer in American adults 16-33 years of age. AYAs with thyroid cancer face challenges including overdiagnosis reduced healthcare access and inconsistent care. Successful treatment of these patients results in additional challenges due to ongoing side effects of treatment as well as lasting impacts on their quality of life. These challenges should fuel a collaborative research agenda aimed at improving the quality of care for AYAs with thyroid cancer across the spectrum of diagnosis, treatment and survivorship.
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Affiliation(s)
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, & Nutrition. Knowledge & Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic 200, Rochester, MN 55905, USA
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24
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Spitzer AB, Maheshwari AV. Follow-Up/Late Effects Clinics. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Guy GP, Berkowitz Z, Ekwueme DU, Rim SH, Yabroff KR. Annual Economic Burden of Productivity Losses Among Adult Survivors of Childhood Cancers. Pediatrics 2016; 138:S15-S21. [PMID: 27940973 PMCID: PMC6047347 DOI: 10.1542/peds.2015-4268d] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although adult survivors of childhood cancers have poorer health and greater health limitations than other adults, substantial gaps remain in understanding the economic consequences of surviving childhood cancer. Therefore, we estimated the economic burden of productivity losses among adult survivors of childhood cancers. METHODS We examined health status, functional limitations, and productivity loss among adult survivors of childhood cancers (n = 239) diagnosed at ≤14 years of age compared with adults without a history of cancer (n = 304 265) by using the 2004-2014 National Health Interview Survey. We estimated economic burden using the productivity loss from health-related unemployment, missed work days, missed household productivity, and multivariable regression models controlling for age, sex, race/ethnicity, education, comorbidities, and survey year. RESULTS Childhood cancer survivorship is associated with a substantial economic burden. Adult survivors of childhood cancers are more likely to be in poorer health, need assistance with personal care and routine needs, have work limitations, be unable to work because of health, miss more days of work, and have greater household productivity loss compared with adults without a history of cancer (all P < .05). The annual productivity loss for adult survivors of childhood cancer is $8169 per person compared with $3083 per person for individuals without a history of cancer. CONCLUSIONS These findings underscore the importance of efforts to reduce the health and economic burden among adult survivors of childhood cancer. In addition, this study highlights the potential productivity losses that could be avoided during adulthood from the prevention of childhood cancer in the United States.
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Affiliation(s)
- Gery P Guy
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Sun Hee Rim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Heintzman J, Bailey SR, DeVoe J, Cowburn S, Kapka T, Duong TV, Marino M. In Low-Income Latino Patients, Post-Affordable Care Act Insurance Disparities May Be Reduced Even More than Broader National Estimates: Evidence from Oregon. J Racial Ethn Health Disparities 2016; 4:329-336. [PMID: 27105630 DOI: 10.1007/s40615-016-0232-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and non-Hispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Cross-sectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status. METHODS Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014. FINDINGS Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014. CONCLUSION Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort.
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Affiliation(s)
- John Heintzman
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Mail Code FM, Portland, OR, 97239, USA.
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Mail Code FM, Portland, OR, 97239, USA
| | - Jennifer DeVoe
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Mail Code FM, Portland, OR, 97239, USA.,OCHIN, Inc, 1881 SW Naito Pkwy, Portland, OR, 97201, USA
| | - Stuart Cowburn
- OCHIN, Inc, 1881 SW Naito Pkwy, Portland, OR, 97201, USA
| | - Tanya Kapka
- Virginia Garcia Memorial Health Center, 2935 SW Cedar Hills Blvd, Beaverton, OR, 97005, USA
| | - Truc-Vi Duong
- Oakland University William Beaumont School of Medicine, 2200 N Squirrel Rd, Rochester, MI, 48309, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Mail Code FM, Portland, OR, 97239, USA.,Division of Biostatistics, Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Drive, Mail Code FM, Portland, OR, 97239, USA
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Health insurance coverage, care accessibility and affordability for adult survivors of childhood cancer: a cross-sectional study of a nationally representative database. J Cancer Surviv 2016; 10:964-971. [PMID: 27072683 DOI: 10.1007/s11764-016-0542-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/02/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE We describe national patterns of health insurance coverage and care accessibility and affordability in a national sample of adult childhood cancer survivors (CCS) compared to adults without cancer. METHODS Using data from the 2010-2014 National Health Interview Survey (NHIS), we selected a sample of all CCS age 21 to 65 years old and a 1:3 matched sample of controls without a history of cancer. We examined insurance coverage, care accessibility and affordability in CCS and controls. We tested for differences in the groups in bivariate analyses and multivariable logistic regression models. RESULTS Of all respondents age 21-65 in the full NHIS sample, 443 (0.35 %) were CCS. Fewer CCS were insured (76.4 %) compared to controls (81.4 %, p = 0.067). Significantly more CCS reported delaying medical care (24.7 vs 13.0 %), needing but not getting medical care in the previous 12 months (20.0 vs 10.0 %), and having trouble paying medical bills (40.3 vs 19.7 %) compared to controls (p < 0.0001 for all). More CCS reported trouble with care affordability in the previous 12 months compared to controls on six categories of care and for a combined measure of affordability (p < 0.0001 for composite of all). Adjusted analyses demonstrated that these differences comparing CCS to controls remained significant. CONCLUSIONS CCS report problems with health care accessibility and affordability. These analyses support the development of policies to assure that CCS have access to affordable services. IMPLICATIONS FOR CANCER SURVIVORS Efforts to improve access to high-quality and affordable insurance for CCS may help reduce the gaps in getting medical care and problems with affordability. Health care providers should be aware that such problems exist and should discuss affordability and ability to obtain care with patients.
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Financial burden of therapy in families with a child with acute lymphoblastic leukemia: report from north India. Support Care Cancer 2015; 24:103-108. [PMID: 25940031 DOI: 10.1007/s00520-015-2757-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In a low-income country, a child with cancer has severe financial implications for the family. Invariably, patients have to self-finance their therapy. "Out-of-pocket" expenses tend to be high. Also, parents may face loss of job or business resulting in loss of income. Our objective was to assess the financial burden in families with a child with cancer. PROCEDURE The cost to a family with a child with acute lymphoblastic leukemia (ALL) during the first month of therapy was analyzed. Fifty families were given a cost diary in which details of expenditure (direct medical costs, living costs, transport cost) and lost income/employment were recorded. RESULTS The families evaluated came from a distance of 260 ± 218 km from hospital. Most families belonged to upper lower category (62%). The medical expenditure amounted to US dollar (USD) 524 (interquartile range (IQR) 395-777). Nonmedical expenditure was USD 207 (IQR 142-293), the maximum expenditure being on food. The monthly expenses were 7.2 times the monthly per capita income of India which was Indian rupee (INR) 5729 (USD 97) in 2012-2013. Thirty-nine families got financial help (USD 800-3225) from various sources, within 6 months of application. Of the families, 72% families suffered loss of income, 34% fathers lost their jobs. CONCLUSIONS Families spend up to seven times their monthly income over a period of 1 month on an unforeseen illness. Despite financial aid from various sources, nonmedical costs amount to nearly 2.5 times the average per capita income. Universal health insurance is the need of the hour.
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Hudson MM, Oeffinger KC, Jones K, Brinkman TM, Krull KR, Mulrooney DA, Mertens A, Castellino SM, Casillas J, Gurney JG, Nathan PC, Leisenring W, Robison LL, Ness KK. Age-dependent changes in health status in the Childhood Cancer Survivor cohort. J Clin Oncol 2014; 33:479-91. [PMID: 25547510 DOI: 10.1200/jco.2014.57.4863] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To compare age-dependent changes in health status among childhood cancer survivors and a sibling cohort. METHODS Adult survivors of childhood cancer and siblings, all participants of the Childhood Cancer Survivor Study, completed three surveys assessing health status. At each of three time points, participants were classified as having poor outcomes in general health, mental health, function, or daily activities if they indicated moderate to extreme impairment. Generalized linear mixed models were used to compare survivors with siblings for each outcome as a function of age and to identify host- and treatment-related factors associated with age-dependent worsening health status. RESULTS Adverse health status outcomes were more frequent among survivors than siblings, with evidence of a steeper trajectory of age-dependent change among female survivors with impairment in at least one health status domain (P = .01). In adjusted models, survivors were more likely than siblings to report poor general health (prevalence ratio [PR], 2.37; 95% CI, 2.09 to 2.68), adverse mental health (PR, 1.66; 95% CI, 1.52 to 1.80), functional impairment (PR, 4.53; 95% CI, 3.91 to 5.24), activity limitations (PR, 2.38; 95% CI, 2.12 to 2.67), and an adverse health status outcome in any domain (PR, 2.10; 95% CI, 1.97 to 2.23). Cancer treatment and health behaviors influence the magnitude of differences by age groups. Chronic conditions were associated with adverse health status outcomes across organ systems. CONCLUSION The prevalence of poor health status is higher among survivors than siblings, increases rapidly with age, particularly among female participants, and is related to an increasing burden of chronic health conditions.
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Affiliation(s)
- Melissa M Hudson
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada.
| | - Kevin C Oeffinger
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kendra Jones
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Tara M Brinkman
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kevin R Krull
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Daniel A Mulrooney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ann Mertens
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Sharon M Castellino
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jacqueline Casillas
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - James G Gurney
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paul C Nathan
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Wendy Leisenring
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Leslie L Robison
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kirsten K Ness
- Melissa M. Hudson, Kendra Jones, Tara M. Brinkman, Kevin R. Krull, Daniel A. Mulrooney, James G. Gurney, Leslie L. Robison, Kirsten K. Ness, St Jude Children's Research Hospital; James G. Gurney, University of Memphis School of Public Health, Memphis, TN; Kevin C. Oeffinger, Memorial Sloan-Kettering Cancer Center, New York, NY; Ann Mertens, Emory University, Children's Healthcare of Atlanta, Atlanta, GA; Sharon M. Castellino, Wake Forest School of Medicine, Winston-Salem, NC; Jacqueline Casillas, University of California, Los Angeles, Los Angeles, CA; Wendy Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Paul C. Nathan, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Heintzman J, Marino M, Hoopes M, Bailey S, Gold R, Crawford C, Cowburn S, O'Malley J, Nelson C, DeVoe JE. Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients. Prev Med 2014; 67:306-10. [PMID: 25124279 PMCID: PMC4363138 DOI: 10.1016/j.ypmed.2014.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/28/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study compared the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period, using electronic health record (EHR) data. METHODS We performed a retrospective cohort analysis, using logistic mixed effects regression modeling to calculate odds ratios and rates of preventive service utilization for patients without insurance, or with continuous insurance. RESULTS CHCs provided many preventive services to uninsured patients. Uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services, ranging from OR 0.52 (95% CI: 0.35-0.77) for mammogram orders to 0.75 (95% CI: 0.66-0.86) for lipid panels. This disparity persisted even in patients who visited the clinic regularly. CONCLUSION Lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC. Policymakers in the United States should continue to address this significant prevention disparity.
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Affiliation(s)
- John Heintzman
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
| | - Megan Hoopes
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States.
| | - Steffani Bailey
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1098, United States.
| | - Courtney Crawford
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
| | - Stuart Cowburn
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States.
| | - Jean O'Malley
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
| | - Christine Nelson
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR 97201, United States.
| | - Jennifer E DeVoe
- Oregon Health & Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Rd., FM, Portland, OR 97239, United States.
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Parsons H, Schmidt S, Harlan L, Kent E, Lynch C, Smith A, Keegan T. Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study. Cancer 2014; 120:2352-60. [PMID: 24899580 PMCID: PMC4108530 DOI: 10.1002/cncr.28685] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2013] [Accepted: 02/25/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Young adults have historically been the least likely to have health insurance in the United States. Previous studies of survivors of childhood cancer found lower rates of insurance and less access to medical care compared with siblings; however, to the authors' knowledge, no studies to date have examined continuity of insurance after a cancer diagnosis in adolescents and young adults (AYAs). METHODS Using the AYA Health Outcomes and Patient Experience study, a cohort of 465 individuals aged 15 to 39 years from participating Surveillance, Epidemiology, and End Results registries, we evaluated changes in and sponsors of health insurance coverage after diagnosis, coverage of physician-recommended tests, and factors associated with lack of insurance after a cancer diagnosis using chi-square tests and multivariable logistic regression. RESULTS Greater than 25% of AYA survivors of cancer (118 survivors) experienced some period without insurance up to 35 months after diagnosis. Insurance rates were high in the initial year after diagnosis (6 months-14 months; 93.3%) but decreased substantially at follow-up (15 months-35 months; 85.2%). The most common sponsor of health insurance was employer/school coverage (43.7%). Multivariable analysis indicated that older survivors (those aged 25-39 years vs 15-19 years; odds ratio, 3.35 [P < .01]) and those with less education (high school or less vs college graduate; odds ratio, 2.80 [P < .01]) were more likely to experience a period without insurance after diagnosis. Furthermore, > 20% of survivors indicated there were physician-recommended tests/treatments that were not covered by insurance, but > 80% received them regardless of coverage. CONCLUSIONS Insurance rates appear to decrease with time since diagnosis in AYA survivors of cancer. Future studies should examine how new policies under the Patient Protection and Affordable Care Act extend access and insurance coverage beyond initial treatment.
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Affiliation(s)
- Helen Parsons
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX
| | - Susanne Schmidt
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX
| | - Linda Harlan
- Applied Research Program, National Cancer Institute, Bethesda, MD
| | - Erin Kent
- Applied Research Program, National Cancer Institute, Bethesda, MD
| | - Charles Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA
| | - Ashley Smith
- Applied Research Program, National Cancer Institute, Bethesda, MD
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Keegan THM, Tao L, DeRouen MC, Wu XC, Prasad P, Lynch CF, Shnorhavorian M, Zebrack BJ, Chu R, Harlan LC, Smith AW, Parsons HM. Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers? J Cancer Surviv 2014; 8:282-92. [PMID: 24408440 PMCID: PMC4074375 DOI: 10.1007/s11764-013-0332-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/29/2013] [Indexed: 12/01/2022]
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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Affiliation(s)
- Theresa H M Keegan
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA,
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Effinger KE, Migliorati CA, Hudson MM, McMullen KP, Kaste SC, Ruble K, Guilcher GMT, Shah AJ, Castellino SM. Oral and dental late effects in survivors of childhood cancer: a Children's Oncology Group report. Support Care Cancer 2014; 22:2009-19. [PMID: 24781353 PMCID: PMC4118932 DOI: 10.1007/s00520-014-2260-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 04/16/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Multi-modality therapy has resulted in improved survival for childhood malignancies. The Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers provide practitioners with exposure- and risk-based recommendations for the surveillance and management of asymptomatic survivors who are at least 2 years from completion of therapy. This review outlines the pathophysiology and risks for oral and dental late effects in pediatric cancer survivors and the rationale for oral and dental screening recommended by the Children's Oncology Group. METHODS An English literature search for oral and dental complications of childhood cancer treatment was undertaken via MEDLINE and encompassed January 1975 to January 2013. Proposed guideline content based on the literature review was approved by a multi-disciplinary panel of survivorship experts and scored according to a modified version of the National Comprehensive Cancer Network "Categories of Consensus" system. RESULTS The Children's Oncology Group oral-dental panel selected 85 relevant citations. Childhood cancer therapy may impact tooth development, salivary function, craniofacial development, and temporomandibular joint function placing some childhood cancer survivors at an increased risk for poor oral and dental health. Additionally, head and neck radiation and hematopoietic stem cell transplantation increase the risk of subsequent malignant neoplasms in the oral cavity. Survivors require routine dental care to evaluate for potential side effects and initiate early treatment. CONCLUSIONS Certain childhood cancer survivors are at an increased risk for poor oral and dental health. Early identification of oral and dental morbidity and early interventions can optimize health and quality of life.
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Affiliation(s)
- Karen E Effinger
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Stanford University, 1000 Welch Rd, Suite 300, Palo Alto, CA, 94304, USA,
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Cost-effectiveness of follow-up services for childhood cancer survivors outside the cancer setting. Curr Opin Support Palliat Care 2014; 7:314-7. [PMID: 23912391 DOI: 10.1097/spc.0b013e328363959e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To provide a brief review of literature published since January 2012 on the subject of the cost-effectiveness of follow-up services for childhood cancer survivors. A pragmatic literature review was carried out to identify relevant literature. RECENT FINDINGS There is very little literature or evidence around the cost-effectiveness of follow-up services for the survivors of childhood cancer. The literature that is partially relevant focuses on the need for follow-up services to change to allow a more risk-based, personalized approach for survivors. There are implications in these changes for the costs and effectiveness of services. Some current literature also focuses on the economic impact of childhood cancer and treatment on the individual. SUMMARY There is considerable interest in understanding whether innovative approaches to follow-up care are cost-effective. There is little evidence currently but new models of care imply a potential shift in the resources required from the hospital setting to care provided outside hospitals. The rapid growth in numbers of survivors means that traditional hospital-based follow-up services will continue to experience high demand so it is important that new models of care are cost-effective.
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Abstract
Increasing cure rates for childhood cancers have resulted in a population of adult childhood cancer survivors (CCS) that are at risk for late effects of cancer-directed therapy. Our objective was to identify facilitators and barriers to primary care physicians (PCPs) providing late effects screening and evaluate information tools PCPs perceive as useful. We analyzed surveys from 351 practicing internal medicine and family practice physicians nationwide. A minority of PCPs perceived that their medical training was adequate to recognize late effects of chemotherapy (27.6%), cancer surgery (36.6%), and radiation therapy (38.1%). Most PCPs (93%) had never used Children's Oncology Group guidelines, but 86% would follow their recommendations. Most (84% to 86%) PCPs stated that they had never received a cancer treatment summary or survivorship care plan but (>90%) thought these documents would be useful. PCPs have a low level of awareness and receive inadequate training to recognize late effects. Overall, PCPs infrequently utilize guidelines, cancer treatment summaries, and survivorship care plans, although they perceive such tools as useful. We have identified gaps to address when providing care for CCS in routine general medical practice.
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Affiliation(s)
- Jody L Sima
- *Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY †Indiana University School of Medicine ‡VA Health Services Research & Development Center for Health Information and Communication, Roudebush VAMC §Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine ∥IU Center for Health Services and Outcomes Research, Regenstrief Institute Inc., Indianapolis, IN
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Robin Yabroff K, Short PF, Machlin S, Dowling E, Rozjabek H, Li C, McNeel T, Ekwueme DU, Virgo KS. Access to preventive health care for cancer survivors. Am J Prev Med 2013; 45:304-12. [PMID: 23953357 PMCID: PMC3804250 DOI: 10.1016/j.amepre.2013.04.021] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/22/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Access to health care, particularly effective primary and secondary preventive care, is critical for cancer survivors, in order to minimize the adverse sequelae of cancer and its treatment. PURPOSE The goal of the study was to evaluate the association between cancer survivorship and access to primary and preventive health care. METHODS Cancer survivors (n=4960) and individuals without a cancer history (n=64,431) aged ≥ 18 years, from the 2008-2010 Medical Expenditure Panel Survey (MEPS), were evaluated. Multiple measures of access and preventive services use were compared. The association between cancer survivorship and access and preventive services was evaluated with multivariate logistic regression models, stratified by age group (18-64 years and ≥ 65 years), controlling for the effects of age, gender, race/ethnicity, education, marital status, and comorbidities. Data were analyzed in 2013. RESULTS Cancer survivors aged ≥ 65 years had equivalent or greater access and preventive services use than individuals without a cancer history, in adjusted analyses. However, among those aged 18-64 years with private health insurance, cancer survivors were more likely than other individuals to have a usual source of care and to use preventive services, whereas uninsured or publicly insured cancer survivors were generally less likely to have a usual source of care and to use preventive services than were uninsured or publicly insured adults without a cancer history. CONCLUSIONS Although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18-64 years suggest that improvements in survivor care are needed.
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Affiliation(s)
- K Robin Yabroff
- Division of Cancer Control and Population Sciences, Health Services and Economics Branch, National Cancer Institute, Rockville, MD 20850, USA.
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Oliveira BAD, Lins MM, Pedrosa F, Cabral PC, Barbosa JM. Estado nutricional de crianças e adolescentes sobreviventes de leucemia linfoide aguda tratados em um Centro de Referência da Região Nordeste do Brasil. REV NUTR 2013. [DOI: 10.1590/s1415-52732013000300002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJETIVO: Avaliar o estado nutricional e os fatores clínicos, laboratoriais e comportamentais associados ao excesso de peso em crianças e adolescentes sobreviventes de leucemia linfoide aguda, tratados em um centro de referência da Região Nordeste do Brasil. MÉTODOS: Estudo de série de casos com 30 sobreviventes de leucemia linfoide aguda. Entre os meses de março e setembro de 2011, foram coletados dados clínicos, comportamentais e laboratoriais. O diagnóstico antropométrico foi realizado em três ocasiões distintas: no momento do diagnóstico, no término do tratamento, e no período pós-tratamento, a partir dos índices altura/idade e índice de massa corporal/idade, segundo a Organização Mundial de Saúde. RESULTADOS: A amostra tinha idade média de 10,2 anos (DP=3,2). Observou-se que 33,3% dos sobreviventes tinham excesso de peso no início e no término do tratamento. No período pós-tratamento, encontrou-se aumento significante do escore-Z de índice de massa corporal/idade, e uma frequência de 43,3% de excesso de peso, além de 16,6% e 35,5% de obesidade abdominal por meio da circunferência da cintura e razão cintura/estatura respectivamente. O crescimento linear foi significativamente diminuído quando comparado os escores-Z de altura/idade no início e no término do tratamento. Na análise dos dados laboratoriais, obtiveram-se 52,1% com colesterol total acima do recomendado. Entretanto, 58,3%, 66,7% e 79,2% evidenciaram, respectivamente, Lipoproteína de Alta Densidade e Lipoproteína de Baixa Densidade-colesterol e triglicerídeo na faixa considerada desejável. CONCLUSÃO: Os sobreviventes de leucemia linfoide aguda analisados apresentaram maior risco para o desenvolvimento de doenças crônicas não transmissíveis uma vez que apresentam frequência importante de excesso de peso, obesidade abdominal e colesterol total elevado.
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Murphy MH. Health promotion in adolescent and young adult cancer survivors: mobilizing compliance in a multifaceted risk profile. J Pediatr Oncol Nurs 2013; 30:139-52. [PMID: 23625640 DOI: 10.1177/1043454213486194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
With rising cure rates of childhood cancer, nurse practitioners have an increased chance of encountering a large survivor cohort in practice. A variety of late effects programs exist; however, funding is limited for these programs and is not accessible for all patients. Primary providers may increasingly act as a medical home for childhood cancer survivors (CCS). Understanding the inherent risks of cytotoxic treatment and the progressive consequences of late effects is vital to limit morbidity and mortality. Adolescent and young adult survivors (AYA) are particularly apt to make health behavior decisions that create risks for comorbidities. Developmentally appropriate experimentation with drug, alcohol, or tobacco use and increased ultraviolet ray exposure intensifies the risk for secondary malignancies and novel diseases. The paucity of evidence-based surveillance guidelines and survivor-specific health promotion programs cumulatively widen the gap in noncompliance and misinformation. This article overviews the risk profile of CCS. It explores health practices, as well as emerging health promotion techniques, within the AYA survivor population and the role nurse practitioners have in enhancing health maintenance.
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Cheung WY, Aziz N, Noone AM, Rowland JH, Potosky AL, Ayanian JZ, Virgo KS, Ganz PA, Stefanek M, Earle CC. Physician preferences and attitudes regarding different models of cancer survivorship care: a comparison of primary care providers and oncologists. J Cancer Surviv 2013; 7:343-54. [PMID: 23526165 DOI: 10.1007/s11764-013-0281-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 03/08/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE New strategies for delivering cancer follow-up care are needed. We surveyed primary care providers (PCPs) and oncologists to assess how physician attitudes toward and self-efficacy with cancer follow-up affect preferences for different cancer survivorship models. METHODS The survey of physician attitudes regarding the care of cancer survivors was mailed to a randomly selected national sample of PCPs and oncologists to evaluate their perspectives regarding physician roles, knowledge about survivorship care processes, and views on cancer surveillance. Multinomial logistic regression models were constructed to examine how physician attitudes towards, and self-efficacy with, their own skills affected preferences for different cancer survivorship care models. RESULTS Of 3,434 physicians identified, a total of 2,026 participants provided eligible responses: 938 PCPs and 1,088 oncologists. Most PCPs (51 %) supported a PCP/shared care model; whereas, the majority of specialists (59 %) strongly endorsed an oncologist-based model (p < 0.001). Less than a quarter of PCPs and oncologists preferred specialized survivor clinics. A significant proportion of oncologists (87 %) did not feel that PCPs should take on the primary role of cancer follow-up. Most PCPs believed that they were better able to perform breast and colorectal cancer follow-up (57 %), detect recurrent cancers (74 %), and offer psychosocial support (50 %), but only a minority (32 %) was willing to assume primary responsibility. PCPs already involved with cancer surveillance (43 %) were more likely to prefer a PCP/shared care than oncologist-based survivorship model (OR, 2.08; 95 % CI, 1.34-3.23). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS PCPs and oncologists have different preferences for models of cancer survivorship care. Prior involvement with cancer surveillance was one of the strongest predictors of PCPs' willingness to assume this responsibility.
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Affiliation(s)
- Winson Y Cheung
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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Kirchhoff AC, Lyles CR, Fluchel M, Wright J, Leisenring W. Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer. Cancer 2012; 118:5964-72. [PMID: 23007632 DOI: 10.1002/cncr.27537] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 02/02/2012] [Accepted: 02/21/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Health care outcomes for long-term survivors of adolescent and young adult (AYA) cancer were compared with young adults without a cancer history, using the 2009 Behavioral Risk Factor Surveillance System data. METHODS Eligible participants were 20 to 39 years of age. There were N = 979 who self-reported a cancer diagnosis between the ages of 15 to 34 years and were at least 5 years from diagnosis (excluding nonmelanoma skin cancer). The remaining 67,216 participants with no cancer history were used as controls. Using multivariable regressions, relative risks and 95% confidence intervals were generated to examine the relationship of survivor status on indicators of poor health care (uninsured, no personal health care provider, no routine care, and avoiding seeing a doctor due to cost). Adjusted proportions were calculated by demographic groups. Results are weighted by Behavioral Risk Factor Surveillance System survey design. RESULTS Although the proportion uninsured did not differ (21% of survivors vs 23% of controls), AYA survivors reported forgoing care due to cost at higher levels than controls (relative risk = 1.67, 95% CI = 1.44-1.94). Cost barriers were particularly high for survivors aged 20 to 29 years (44% vs 16% of controls; P < .001) and female survivors (35% vs 18% of controls; P < .001). Survivors reporting poorer health had more cost barriers. Moreover, uninsured survivors tended to report lower use of health care than did controls. CONCLUSIONS AYA cancer survivors may forgo health care due to cost barriers, potentially inhibiting the early detection of late effects. Expanding health insurance coverage for young cancer survivors may be insufficient without adequate strategies to reduce their medical cost burdens.
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Affiliation(s)
- Anne C Kirchhoff
- Center for Children's Cancer Research, Huntsman Cancer Institute, Salt Lake City, Utah 84112, USA.
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Park ER, Kirchhoff AC, Zallen JP, Weissman JS, Pajolek H, Mertens AC, Armstrong GT, Robison LL, Donelan K, Recklitis CJ, Diller LR, Kuhlthau KA. Childhood Cancer Survivor Study participants' perceptions and knowledge of health insurance coverage: implications for the Affordable Care Act. J Cancer Surviv 2012; 6:251-9. [PMID: 22592507 PMCID: PMC4706983 DOI: 10.1007/s11764-012-0225-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Childhood cancer survivors face long-term health consequences, and comprehensive health insurance is critical. However, childhood cancer survivors may face barriers in accessing medical services due to being uninsured or underinsured. Little is known about the quality of survivors' health insurance coverage, and improving health insurance within the context of changes mandated by the 2010 Affordable Care Act requires understanding survivors' coverage. The current study explored adult childhood cancer survivors' quality of health insurance coverage. METHODS From 9/09 to 2/10, we conducted in-depth, semistructured qualitative interviews with 39 adult participants from the Childhood Cancer Survivor Study, a cohort of 5-year survivors of cancers diagnosed before age 21. Interviews were recorded and transcribed; content analyses were conducted by two coders (kappa = 0.88) using NVivo 8. RESULTS Most insured survivors reported satisfaction with the quality of their coverage; however, they expressed low expectations. Almost half reported annual out-of-pocket costs exceeding $2,000, yet most felt fortunate to simply have coverage. One third of insured survivors had difficulty obtaining coverage, and many had difficulties understanding how to utilize it. Most uninsured survivors minimized their need for care. Worry about future health care costs seemed inevitable among insured and uninsured survivors. Almost all participants lacked knowledge about existing health insurance-related laws. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Insured survivors had low coverage expectations, and uninsured survivors avoided care. Childhood cancer survivors will likely benefit from assistance in how to access and utilize the new health care reform provisions (e.g., Medicaid expansion, expansion of parents' insurance, and mandatory primary care coverage).
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Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital, Boston, MA 02114, USA.
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