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Annals of Family Medicine 2:61-70 (2004)
© 2004 Annals of Family Medicine, Inc.
doi: 10.1370/afm.26
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Article

Health Care of Young Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study

Kevin C. Oeffinger, MD1, Ann C. Mertens, PhD2, Melissa M. Hudson, MD3, James G. Gurney, PhD2, Jacqueline Casillas, MD4, Hegang Chen, PhD5, John Whitton, MS6, Mark Yeazel, MD, MPH7, Yutaka Yasui, PhD6 and Leslie L. Robison, PhD2

1 Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
2 Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minn
3 Departments of Hematology–Oncology and Behavioral Medicine, St. Jude Children’s Research Hospital, Memphis, Tenn
4 Department of Pediatrics, School of Medicine, University of California, Los Angeles, Calif
5 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minn
6 Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Wash
7 Department of Family Practice and Community Health, School of Medicine, University of Minnesota, Minneapolis, Minn

CORRESPONDING AUTHOR: Kevin C. Oeffinger, MD, Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center at Dallas, 6263 Harry Hines Blvd, Dallas, TX 75390-9067, kevin.oeffinger{at}utsouthwestern.edu

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.

Key Words: Survivors • neoplasms • delivery of health care • cohort




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TRACK Comments:

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Further Thoughts on Follow-up Care
Linda Goettina
Annals of Family Medicine, 28 Jan 2004 [Full text]
Recognizing the medical needs of childhood cancer survivors
Martin C. Mahoney
Annals of Family Medicine, 28 Jan 2004 [Full text]
Important Discussion Regarding Long-term follow-up care
Doug Ulman
Annals of Family Medicine, 28 Jan 2004 [Full text]
Providing Comprehensive Care to Adult Survivors of Childhood Cancer.
Wendy Hobbie
Annals of Family Medicine, 28 Jan 2004 [Full text]
Young Adults Cured of Childhood Cancer: What is the "Quality" of the Cure?
George R. Buchanan, M.D.
Annals of Family Medicine, 28 Jan 2004 [Full text]
Healthcare Utilization by Childhood Cancer Survivors - where do we go next?
Smita Bhatia
Annals of Family Medicine, 29 Jan 2004 [Full text]
Clinical Follow-Up of Childhood Cancer Survivors
Michael M Hawkins, et al.
Annals of Family Medicine, 29 Jan 2004 [Full text]
Health care of adult survivors of childhood cancer
Charles A Sklar, MD
Annals of Family Medicine, 29 Jan 2004 [Full text]
additional comments on the insurance question
Linda Goettina
Annals of Family Medicine, 29 Jan 2004 [Full text]
Childhood Cancer Survivors and long-term follow-up care
Brad J. Zebrack
Annals of Family Medicine, 29 Jan 2004 [Full text]
Systemic and psychological barriers to survivor care: Comment on Oeffinger et al.
Christopher J Recklitis
Annals of Family Medicine, 30 Jan 2004 [Full text]
Needed: A Study of the Health Care of Older Adult Survivors of Childhood Cancer
Karen M. McIver, et al.
Annals of Family Medicine, 30 Jan 2004 [Full text]
Long-Term Survivors of Childhood Cancers Need Help
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Assuring care for childhood cancer survivors
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Are post-traumatic stress and health care utilization related?
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