Lack of Routine Health Care Among Adult Survivors of Childhood, Adolescent, and Young Adult Cancers (CAYA): A Nationally Representative Study of 4300 Survivors.

BACKGROUND

Survivors of childhood, adolescent, and young adult cancers (CAYA) experience lifelong health risks and accelerated aging. We examined routine health care (no routine checkup in the past year) among a nationally representative sample of CAYA survivors at different life stages.

METHODS

We pooled data from the Behavioral Risk Factor Surveillance System (BRFSS; 2012, 2014, 2016-2019). CAYA survivors (ages 0-39 at cancer diagnosis) were young adults (18-39 years), middle-aged (40-64 years), or older adults (≥ 65 years) at the time of the survey. We estimated the prevalence of: (1) not receiving routine health care and (2) not having a personal doctor, overall and by age at survey. We used multivariable Poisson regression to identify factors associated with these outcomes.

RESULTS

We identified 4284 CAYA survivors: 884 young adults, 2201 middle-aged, and 1199 older adults. More young adults were uninsured and unable to afford care, compared to other age groups. A higher proportion of young adults did not receive routine health care (35.9%, 95% CI 30.3-41.9) or have a personal doctor (25.6%, 95% CI 20.5-31.4), compared to middle-aged or older CAYA survivors (p < 0.01). In multivariable models, being a young adult was strongly associated with (1) not receiving routine health care (aPR 1.82, 95% CI 1.24-2.67) and (2) not having a personal doctor (aPR 3.14, 95% CI 1.84-5.35).

CONCLUSIONS

Younger CAYA survivors experience a triple threat of chronic conditions, modifiable risks, and disconnection from routine health care.

IMPACT

Early interventions to facilitate care transitions are needed.