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. 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

Jacqueline Casillas  1 , Kevin C Oeffinger  2 , Melissa M Hudson  3 , Mark L Greenberg  4 , Mark W Yeazel  5 , Kirsten K Ness  6 , Tara O Henderson  7 , Leslie L Robison  6 , Gregory T Armstrong  3 , Qi Liu  8 , Wendy Leisenring  9 , Yutaka Yasui  8 , Paul C Nathan  4
Affiliations

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

Jacqueline Casillas et al. Health Serv Res. 2015 Aug.

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.

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Figures

Figure 1
Figure 1
Consort Diagram of Eligible Participants
Figure 2
Figure 2
Number of Survivors Reporting Each Level of Care at Follow-Up Stratified by Level of Care at Baseline
See this image and copyright information in PMC

References

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