Journal of Cancer Survivorship

, Volume 8, Issue 2, pp 282–292

Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?

  • Theresa H. M. Keegan
  • Li Tao
  • Mindy C. DeRouen
  • Xiao-Cheng Wu
  • Pinki Prasad
  • Charles F. Lynch
  • Margarett Shnorhavorian
  • Brad J. Zebrack
  • Roland Chu
  • Linda C. Harlan
  • Ashley W. Smith
  • Helen M. Parsons
  • AYA HOPE Study Collaborative Group



Adolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored.


We studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used.


Most AYA cancer survivors (95 %), who were 15–35 months post diagnosis, received medical care in the past 12 months and 17 % were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95 % confidence interval (CI) = 1.7–13.8) or have had health insurance in the past year (OR = 4.0; 95 % CI = 0.99–16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25 % of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys.


AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance.

Implications for Cancer Survivors

Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.


Cancer survivors Adolescent and young adult Health insurance Cancer care 


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Theresa H. M. Keegan
    • 1
    • 2
  • Li Tao
    • 1
  • Mindy C. DeRouen
    • 1
  • Xiao-Cheng Wu
    • 3
  • Pinki Prasad
    • 4
  • Charles F. Lynch
    • 5
  • Margarett Shnorhavorian
    • 6
    • 7
  • Brad J. Zebrack
    • 8
  • Roland Chu
    • 9
  • Linda C. Harlan
    • 10
  • Ashley W. Smith
    • 10
  • Helen M. Parsons
    • 11
  • AYA HOPE Study Collaborative Group
  1. 1.Cancer Prevention Institute of CaliforniaFremontUSA
  2. 2.Department of Health Research and PolicyStanford University School of MedicineStanfordUSA
  3. 3.Epidemiology Program, School of Public HealthLouisiana State University Health Sciences CenterNew OrleansUSA
  4. 4.Department of Pediatrics, Children’s Hospital of New OrleansLouisiana State University Health Sciences CenterNew OrleansUSA
  5. 5.Department of EpidemiologyUniversity of IowaIowa CityUSA
  6. 6.Department of UrologyUniversity of WashingtonSeattleUSA
  7. 7.Division of Pediatric UrologySeattle Children’s HospitalSeattleUSA
  8. 8.School of Social WorkUniversity of MichiganAnn ArborUSA
  9. 9.Department of PediatricsWayne State University School of MedicineDetroitUSA
  10. 10.Applied Research Program, Division of Cancer Control and Population SciencesNational Cancer Institute, National Institutes of HealthBethesdaUSA
  11. 11.Department of Epidemiology and Biostatistics, School of MedicineThe University of Texas Health Science CenterSan AntonioUSA

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