Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

Abstract

Background: We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care.

Methods: We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center.

Results: Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97-2.77), male sex (OR = 1.65; 95% CI, 1.44-1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36-1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35-1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer.

Conclusions: Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.

Figure 1.

Percentage of adult survivors of childhood cancer with medical visits in a 2-year period by interval from cancer diagnosis to baseline questionnaire. * Trend significant with P <.001 for general physical education, cancer-related medical visit, and cancer center medical visit by Cochran-Armitage trend test.

Figure 2.

Percentage of adult survivors of 4 higher risk cancer groups with a cancer-related medical visit in a 2-year period by interval from cancer diagnosis to baseline questionnaire. Note: Trend significant with P <.001 for bone tumor, central nervous system (CNS) tumor, Hodgkin’s disease, and leukemia survivors by Cochran-Armitage trend test.