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Health Serv Res. 2015 Aug;50(4):1021-42. doi: 10.1111/1475-6773.12282. Epub 2015 Jan 20.

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

Author information

  • 1Department of Pediatrics, University of California, Los Angeles, CA.
  • 2Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY.
  • 3Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
  • 4Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
  • 5Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
  • 6Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
  • 7The University of Chicago Medicine Comer Children's Hospital, Chicago, IL.
  • 8Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
  • 9Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA.

Abstract

OBJECTIVES:

Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer.

DATA SOURCES:

The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer.

STUDY DESIGN:

Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care.

DATA COLLECTION:

There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up.

PRINCIPAL FINDINGS:

Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤ high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for <high school and high school, respectively) were associated with no care at follow-up. Survivors with severe or life-threatening conditions at baseline (RR 0.5; 95 percent CI 0.3-0.6) were less likely to report no care at follow-up.

CONCLUSIONS:

While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.

KEYWORDS:

Childhood cancer survivors; delivery of health care; health care access; health insurance; survivorship

PMID:
25600956
PMCID:
PMC4545345
DOI:
10.1111/1475-6773.12282
[PubMed - indexed for MEDLINE]
Free PMC Article
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