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Health care experiences of long-term survivors of adolescent and young adult cancer

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Abstract

Purpose

Evaluate health care access and experiences with care among long-term survivors of adolescent and young adult (AYA) cancer relative to a comparison group in the USA.

Methods

The 2008 to 2012 Medical Expenditure Panel Surveys identified 1163 survivors of cancer, diagnosed ages 15–39, current ages 20–64, who were at least 5 years after diagnosis. A comparison group without cancer was matched using age, sex, and other characteristics. Primary outcomes included having ≥1 visit to doctor’s office/clinic in the previous year and perceived health care quality (0 = worst to 10 = best; categorized as low (0–4), intermediate (5–7), and high (8–10)). Other experience-related outcomes (e.g., having adequate time with providers and providers show respect) were also evaluated. Bivariate analyses compared these outcomes between survivors and the comparison group. Multivariable logistic regressions identified survivor-level factors associated with health care visits and quality.

Results

Survivors had ≥1 visit more often (82.1 vs. 75.8 %, p = 0.005) yet rated their health care quality lower (low or intermediate 30.7 vs. 23.6 %, p < 0.001) than the comparison group. Fewer survivors reported always having enough time with providers (41.7 vs. 54.6 %, p < 0.001) and that providers always show respect (57.5 vs. 67.7 %, p = 0.002). Uninsured survivors were less likely to have ≥1 visit (odds ratio (OR) = 0.26, 95 % confidence interval (CI) 0.17–0.40, p < 0.001) and rated their health care quality lower (OR = 0.25, 95 % CI 0.13–0.48, p < 0.001) than privately insured. Many other factors were associated with visits and quality.

Conclusion

Survivors of AYA cancer reported more health care visits but worse health care experiences than individuals without cancer. Targeted interventions that may improve survivors’ experiences with health care should be evaluated.

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Author information

Authors and Affiliations

  1. University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-1150, USA

    Sapna Kaul

  2. University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA

    Mark Fluchel & Holly Spraker-Perlman

  3. University of Miami, Miami, FL, USA

    Christopher F. Parmeter

  4. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Anne C. Kirchhoff

Authors
  1. Sapna Kaul
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  2. Mark Fluchel
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  3. Holly Spraker-Perlman
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  4. Christopher F. Parmeter
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  5. Anne C. Kirchhoff
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Corresponding author

Correspondence to Sapna Kaul.

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Funding

We gratefully acknowledge funding from the Intermountain Healthcare Foundation and Primary Children’s Hospital Foundation. Additional support was provided by the Huntsman Cancer Foundation and the Huntsman Cancer Institute Cancer Center Support Grant No. P30 CA42014 from National Cancer Institute.

Conflict of interest

Authors (Kaul, Fluchel, Spraker-Perlman, Parmeter, and Kirchhoff) declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Appendix

Appendix

Table 4 Factors associated with health care use and quality ratings among comparison group individuals
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Kaul, S., Fluchel, M., Spraker-Perlman, H. et al. Health care experiences of long-term survivors of adolescent and young adult cancer. Support Care Cancer 24, 3967–3977 (2016). https://doi.org/10.1007/s00520-016-3235-x

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  • DOI: https://doi.org/10.1007/s00520-016-3235-x

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