Introduction: More than 72,000 adolescent and young adults (AYA) ages 15–39 are diagnosed with cancer each year in the United States and the majority will transition to long-term survivorship. Little is known about barriers this population faces in accessing medical care. Using the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data, we compared markers of health care access and utilization for long-term AYA cancer survivors to young adults without a cancer history and examined whether certain demographic groups of survivors are at increased risk for poor health care outcomes.
Methods: Eligible participants were 18–39 years of age at interview. Of these 71,982 respondents, there were N=1003 who self-reported being diagnosed with cancer between the ages of 15–34, were at least 5 years from diagnosis, and did not have non-melanoma skin cancer. Using multivariable generalized linear models we generated relative risks (RR) and 95% confidence intervals (95% CI) to examine the relationship of survivor status on binary indicators of access to and utilization of health care (having a personal health care provider, having at least one routine check-up in the past 12 months, and avoiding seeing a doctor in the past 12 months due to cost). Among survivors, we calculated adjusted proportions reporting the health care measures by age, race, and gender. All results are adjusted for age, race, gender, and as relevant, health insurance, and are reported weighted by BRFSS survey design and for non-response.
Results: For AYA survivors, mean time since diagnosis was 10.5 years (sd=4.3). Average age of AYA survivors was 33.0 years compared to 28.8 for the non-cancer sample (p<0.001), and more AYA survivors were female (81% vs. 49%; p<0.001). Among female survivors, the most common cancer was cervical (51%), while among male survivors, non-Hodgkin lymphoma (20%). More AYA survivors were white (74%) compared to those without cancer (61%; p<0.001). Household income did not significantly differ between the two groups.
Health insurance coverage was similar (78% survivors vs. 77% non-cancer); however, in multivariable regressions, survivors were less likely to report being insured (RR 0.94, 95% CI 0.88–0.99). Report of having a personal medical provider was comparable between the survivors and non-cancer sample (RR 1.02, 95% CI 0.96–1.09). When adjusted proportions were examined, survivors ages 30–39 were more likely to have a provider than survivors ages 18–29 (87% vs. 74%, p=0.02), while gender and race did not differ. AYA survivors and the non-cancer sample reported having at least one routine medical visit in the past year at similar levels (RR 0.97, 95% CI 0.89–1.07). Among survivors, black (81%) compared to white (62%), Hispanic (43%), and other race (65%) survivors were more likely to have had a routine visit (p=0.009), but age and gender did not differ significantly. In our final model, survivors were 70% more likely to report avoiding seeing a doctor in the past 12 months due to cost (RR 1.70, 95% CI 1.48–1.97). Fewer survivors ages 30–39 reported that cost prohibited medical care compared to those ages 18–29 (29% vs. 45%, p=0.05), while there were no differences by race or gender.
Conclusions: Long-term AYA cancer survivors face barriers to accessing health care. Although there were no significant differences in routine medical utilization or having a regular physician, AYA survivors are 70% more likely to forego seeing a medical provider due to cost than those without a history of cancer. Younger survivors, in particular, may face barriers to care. Due to the long-term effects from cancer treatment, AYA cancer survivors require consistent medical surveillance, and our results suggest that improvements in post-treatment health care access should be prioritized for this population.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):B23.