Longitudinal changes in health care utilization by adult survivors of childhood cancer in the Childhood Cancer Survivor Study (CCSS).

6030 Background: The incidence of late effects increases as childhood cancer survivors age. Survivors require lifelong care focused on the risks arising from prior cancer therapy (survivor-focused care). Methods: We assessed longitudinal changes in health care utilization in adult survivors of childhood cancer participating in the CCSS. Utilization at baseline and most recent follow-up was classified into one of three mutually exclusive hierarchical categories: no health care, general medical care, or survivor-focused care. Relative risk (RR) and 95% confidence intervals (CI) were calculated for predictors of reduction in care over time from survivor-focused to general or no care. Multivariable models, adjusted for key treatment exposures, were created to assess the risk factors for reductions in level of care over time. Results: Among 8591 eligible survivors, mean age at last follow-up was 35.1 years (SD=7.8) with a mean of 11.6 years (SD=2.2) since baseline. Of 3993 (46%) survivors who reported survivor-focused care at baseline, 2383 (59.7%) reported a lower level of care at follow-up. Among 4598 (54%) not receiving survivor-focused care at baseline, 915 (20%) reported survivor-focused care at follow-up. Baseline predictors of a decreased level of care were no health insurance (RR=1.5, 95% CI 1.2-1.9), male sex (RR=1.4, 95% CI 1.2-1.6), being 10-19 years from diagnosis compared with 20+ years (RR=1.4, 95% CI 1.1-1.7). In contrast, factors associated with a maintenance in survivor-focused care were Canadian residency compared to U.S. residency with insurance (RR=0.7, 95% CI 0.6-0.9), unemployment (RR=0.8, 95% CI 0.7-0.9), physical limitations (RR=0.7, 95% CI 0.6-0.9), cancer-related pain (RR=0.7, 95% CI 0.5-0.8), poor emotional health (RR=0.7, 95% CI 0.5-0.9), having mild-moderate (RR=0.5, 95% CI 0.4-0.6) or severe-disabling chronic health condition (RR=0.6, 95% CI 0.5-0.7). Conclusions: Less than a third of adult survivors of childhood cancer report survivor-focused care. Rates decrease over time. Targeted interventions to maximize survivor-focused care in at-risk survivors should be tested so preventive and risk-reducing opportunities are not lost.

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Impact of insurance type on survivor-focused and general preventive health care utilization in adult survivors of childhood cancer

Cancer ◽

10.1002/cncr.25688 ◽

2010 ◽

Vol 117 (9) ◽

pp. 1966-1975 ◽

Cited By ~ 31

Author(s):

Jacqueline Casillas ◽

Sharon M. Castellino ◽

Melissa M. Hudson ◽

Ann C. Mertens ◽

Isac S. F. Lima ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Childhood Cancer ◽

Adult Survivors ◽

Preventive Health Care ◽

Preventive Health ◽

Care Utilization ◽

Insurance Type ◽

Survivors Of Childhood Cancer

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Predictors of health care utilization in adult survivors of childhood cancer exposed to central nervous system-directed therapy

Cancer ◽

10.1002/cncr.29121 ◽

2014 ◽

Vol 121 (5) ◽

pp. 774-782 ◽

Cited By ~ 3

Author(s):

Cara I. Kimberg ◽

James L. Klosky ◽

Nan Zhang ◽

Tara M. Brinkman ◽

Kirsten K. Ness ◽

...

Keyword(s):

Health Care ◽

Central Nervous System ◽

Nervous System ◽

Health Care Utilization ◽

Childhood Cancer ◽

Adult Survivors ◽

Care Utilization ◽

Survivors Of Childhood Cancer

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Programs for adult survivors of childhood cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.8.2864 ◽

1998 ◽

Vol 16 (8) ◽

pp. 2864-2867 ◽

Cited By ~ 101

Author(s):

K C Oeffinger ◽

D A Eshelman ◽

G E Tomlinson ◽

G R Buchanan

Keyword(s):

Health Care ◽

Childhood Cancer ◽

Health Care Providers ◽

Primary Care Physicians ◽

Adult Survivors ◽

Care Providers ◽

Care Needs ◽

Survivors Of Childhood Cancer

PURPOSE The potential for late effects of treatment necessitates long-term monitoring of adult survivors of childhood cancer. The purpose of this study was to determine how institutions follow up young adult survivors of pediatric malignancy. Specifically, we were interested in the types of health care providers who follow up these patients, how the follow-up is administered, and what barriers to follow-up have been encountered. METHODS A 16-item questionnaire was mailed to the 219 members of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG). The survey consisted of four categories of questions that asked for information regarding the existence of a program to follow up young adults, the setting of the program, routine activities of the program, and commonly encountered barriers to care. RESULTS One hundred eighty-two members returned the survey (83% response rate). Fifty-three percent of the respondents have a long-term follow-up clinic at their institution. Whereas 44% have a mechanism for following up adult survivors, only 15% of the programs have established a formal database for adults. Nearly all the programs (93%) use a pediatric oncologist. Although an adult oncologist assists in 13% of the programs, primary care physicians are uncommonly (8%) involved. CONCLUSION Few programs focus on the long-term health care needs of adult survivors of childhood cancer. The majority of existing programs are in pediatric institutions, without significant input from adult-oriented, generalist health care providers.

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Minority Adult Survivors of Childhood Cancer: A Comparison of Long-Term Outcomes, Health Care Utilization, and Health-Related Behaviors From the Childhood Cancer Survivor Study

Journal of Clinical Oncology ◽

10.1200/jco.2005.11.098 ◽

2005 ◽

Vol 23 (27) ◽

pp. 6499-6507 ◽

Cited By ~ 72

Author(s):

Sharon M. Castellino ◽

Jacqueline Casillas ◽

Melissa M. Hudson ◽

Ann C. Mertens ◽

John Whitton ◽

...

Keyword(s):

Health Care ◽

Health Status ◽

Health Care Utilization ◽

Childhood Cancer ◽

Cancer Survivor ◽

Adult Survivors ◽

Childhood Cancer Survivor ◽

Care Utilization ◽

Late Mortality ◽

Childhood Cancer Survivor Study

Purpose To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS). Patients and Methods Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors. Results Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking. Conclusion Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.

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Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study

Supportive Care in Cancer ◽

10.1007/s00520-013-1976-3 ◽

2013 ◽

Vol 22 (2) ◽

pp. 339-349 ◽

Cited By ~ 11

Author(s):

Micol E. Gianinazzi ◽

◽

Corina S. Rueegg ◽

Nicolas X. von der Weid ◽

Felix K. Niggli ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Health Care Utilization ◽

Mental Health Care ◽

Childhood Cancer ◽

Cancer Survivor ◽

Care Utilization ◽

Childhood Cancer Survivor Study ◽

Survivors Of Childhood Cancer ◽

Mental Health Care Utilization

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Health Service Use among Individuals with Depression and Psychological Distress: A Population-Based Cohort Study in Ontario, Canada: Utilisation des services de santé par les personnes souffrant de dépression et de détresse psychologique : une étude de cohorte dans la population de l’Ontario, Canada

The Canadian Journal of Psychiatry ◽

10.1177/0706743720927826 ◽

2020 ◽

Vol 65 (9) ◽

pp. 641-651

Author(s):

Maria Chiu ◽

Farah E. Saxena ◽

Paul Kurdyak ◽

Andrew S. Wilton ◽

Simone N. Vigod

Keyword(s):

Health Care ◽

Psychological Distress ◽

Health Care Utilization ◽

Acute Care ◽

Care Utilization ◽

Services De Santé ◽

Unexposed Group ◽

Utilisation Des Services ◽

Over Time

Objectives: Relatively little is known about how health-care utilization differs among individuals with psychological distress compared to those with major depressive disorder (MDD). Methods: Ontario participants of the Canadian Community Health Survey Cycle 1.2 (2002) were linked to health administrative data to follow their health-care utilization patterns for up to 15 years. Based on their survey responses, we classified individuals hierarchically into Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria MDD, psychological distress (Kessler-6: 8 to 24), or an unexposed group with neither condition. We compared the rates of outpatient and acute care mental and nonmental health-related visits across the 3 groups over time using Poisson regression. Results: Among the 430 individuals with MDD, 668 with psychological distress, and 9,089 in the unexposed group, individuals with MDD and psychological distress had higher rates of health-care utilization than the unexposed overall and across time. The rates of psychiatrist visits for the MDD group were significantly higher than the other groups initially but declined over the follow-up. Conversely, the rates of psychiatrist visits among the psychological distress group increased over time and converged with that of the MDD group by the end of follow-up (rate ratioMDD vs. psychological distress at 1 year: 4.20 [1.97 to 11.40]; at 15 years: 1.53 [0.54 to 4.08]). Acute care visits were similar between the MDD and psychological distress groups at all time points. Conclusions: Individuals with psychological distress required mental health care rivalling that of individuals with MDD over time, suggesting that even a cross-sectional assessment of significant psychological distress is a serious clinical concern.

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Change in Pain Status and Subsequent Opioid and Marijuana Use Among Long-Term Adult Survivors of Childhood Cancer

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa070 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

I-Chan Huang ◽

Nicole M Alberts ◽

Merrion G Buckley ◽

Zhenghong Li ◽

Matthew J Ehrhardt ◽

...

Keyword(s):

Childhood Cancer ◽

Marijuana Use ◽

Adult Survivors ◽

Opioid Use ◽

Status Change ◽

Pain Status ◽

Survivors Of Childhood Cancer ◽

Over Time

Abstract We evaluated pain status change and associations with subsequent opioid/marijuana use among 1208 adult survivors of childhood cancer. Pain status and opioid/marijuana were self-reported at baseline and follow-up evaluation (mean interval = 4.2 years). Over time, 18.7% of survivors endorsed persistent/increasing significant pain; 4.8% and 9.0% reported having used opioids and marijuana at follow-up. Persistent/increased (vs none/decreased) pain, persistent/increased (vs none/decreased) anxiety, and lack of health insurance increased odds of subsequent opioid use by 7.69-fold (95% confidence interval [CI] = 3.71 to 15.95), 2.55-fold (95% CI = 1.04 to 6.24), and 2.50-fold (95% CI = 1.07 to 5.82), respectively. Persistent/increased (vs none/decreased) depression increased odds of subsequent marijuana use by 2.64-fold (95% CI = 1.10 to 6.33).

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