Barriers and facilitators of risk-based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

• Type of Material: Article
• Authors: Jennifer S. Ford, City University of New York; Emily S. Tonorezos, Memorial Sloan Kettering Cancer Center; Ann Mertens, Emory University; Melissa M. Hudson, St Jude Childrens Research Hospital; Jacqueline Casillas, University of California Los Angeles; Barbara M. Foster, American Board of Obstetrics & Gynecology; Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center; Stephanie M. Smith, Stanford University; Joanne F. Chou, Memorial Sloan Kettering Cancer Center; George Buchanan, University of Texas Southwestern Medical Center; Leslie L. Robison, St Jude Childrens Research Hospital; Kevin C. Oeffinger, Duke University
• Language: English
• Date: 2019-10-18
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 American Cancer Society.
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.32568
• Title of Journal or Parent Work: Cancer
• Volume: 126
• Issue: 3
• Start Page: 619
• End Page: 627
• Grant/Funding Information: American Cancer Society Cancer Control Career Development Award #121092.; This study was supported by grants from the Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Program (KCO); National Cancer Institute (U24-CA55727, K05-CA165702, CA187397, and P30CA008748)
• Keywords: risk-based care; Adolescent; cancer survivor; Prevalence; childhood cancer; Surveillance; Life Sciences & Biomedicine; barriers; Medical care; Behavioral model; Science & Technology; Oncology; Access; Screening practices
• Research Categories: Health Sciences, Human Development; Health Sciences, Oncology; Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: Optimal risk-based survivor health care includes surveillance for late effects and education targeted at reducing or preventing risky health behaviors. Understanding the reasons for a lack of risk-based follow-up care is essential. Methods: Adult participants from the Childhood Cancer Survivor Study were surveyed about having a cancer-related visit in the past 2 years and the likelihood of having a cancer-related visit in the future. Additional factors thought to be related to the primary outcomes were also assessed. Results: Nine hundred seventy-five survivors completed the survey. Twenty-seven percent (95% confidence interval [CI], 24%-30%) had a cancer-related medical visit in the previous 2 years, and 41% (95% CI, 38%-44%) planned to have such a visit within the next 2 years. The likelihood of having had a cancer-related visit within the last 2 years was higher among survivors assigning greater importance to these visits (relative risk [RR], 1.2; 95% CI, 1.1-1.3), perceiving greater susceptibility to health problems (RR, 1.2; 95% CI, 1.1-1.3), having a moderate to life-threatening chronic health problem related to their cancer (RR, 2.1; 95% CI, 1.7-2.7), seeing a primary care provider for a cancer-related problem (RR, 1.3; 95% CI, 1.0-1.6), having a cancer treatment summary (RR, 1.3; 95% CI, 1.0-1.6), and endorsing greater confidence in physicians' abilities to address questions and concerns (RR, 1.2; 95% CI, 1.0-1.3). Conclusions: Educational interventions improving awareness of treatment history and susceptibility to cancer-related late effects and corresponding risk-based care are likely to be beneficial for survivors of childhood cancers.