Center for Children's Cancer Research, Huntsman Cancer Institute, Salt Lake City, Utah 84112, USA.
Cancer. 2012 Dec 1;118(23):5964-72. doi: 10.1002/cncr.27537. Epub 2012 Sep 24.
Health care outcomes for long-term survivors of adolescent and young adult (AYA) cancer were compared with young adults without a cancer history, using the 2009 Behavioral Risk Factor Surveillance System data.
Eligible participants were 20 to 39 years of age. There were N = 979 who self-reported a cancer diagnosis between the ages of 15 to 34 years and were at least 5 years from diagnosis (excluding nonmelanoma skin cancer). The remaining 67,216 participants with no cancer history were used as controls. Using multivariable regressions, relative risks and 95% confidence intervals were generated to examine the relationship of survivor status on indicators of poor health care (uninsured, no personal health care provider, no routine care, and avoiding seeing a doctor due to cost). Adjusted proportions were calculated by demographic groups. Results are weighted by Behavioral Risk Factor Surveillance System survey design.
Although the proportion uninsured did not differ (21% of survivors vs 23% of controls), AYA survivors reported forgoing care due to cost at higher levels than controls (relative risk = 1.67, 95% CI = 1.44-1.94). Cost barriers were particularly high for survivors aged 20 to 29 years (44% vs 16% of controls; P < .001) and female survivors (35% vs 18% of controls; P < .001). Survivors reporting poorer health had more cost barriers. Moreover, uninsured survivors tended to report lower use of health care than did controls.
AYA cancer survivors may forgo health care due to cost barriers, potentially inhibiting the early detection of late effects. Expanding health insurance coverage for young cancer survivors may be insufficient without adequate strategies to reduce their medical cost burdens.
利用 2009 年行为风险因素监测系统的数据，将青少年和年轻成年人（AYA）癌症长期幸存者的健康结果与无癌症病史的年轻成年人进行了比较。
合格的参与者年龄在 20 至 39 岁之间。共有 979 名参与者自我报告在 15 至 34 岁之间被诊断患有癌症，并且距诊断至少 5 年（不包括非黑色素瘤皮肤癌）。其余 67216 名无癌症病史的参与者被用作对照。通过多变量回归，生成相对风险和 95%置信区间，以检查幸存者状况与不良医疗保健指标（未参保、无私人医疗保健提供者、无常规护理以及因费用而避免看医生）之间的关系。通过人口统计学群体计算调整后的比例。结果通过行为风险因素监测系统调查设计进行加权。
尽管未参保的比例没有差异（幸存者为 21%，对照组为 23%），但 AYA 幸存者因费用而放弃护理的比例高于对照组（相对风险=1.67，95%CI=1.44-1.94）。对于 20 至 29 岁的幸存者（44%比对照组的 16%；P<.001）和女性幸存者（35%比对照组的 18%；P<.001），成本障碍尤其高。报告健康状况较差的幸存者面临更多的成本障碍。此外，未参保的幸存者往往比对照组更不愿意使用医疗保健。
AYA 癌症幸存者可能因费用障碍而放弃医疗保健，这可能会阻碍晚期效应的早期发现。如果没有充分的策略来减轻他们的医疗费用负担，扩大年轻癌症幸存者的健康保险覆盖范围可能还不够。
