Transitions Within and Use of Outpatient Primary and Oncology Care in Survivors of Adolescent and Young Adult-Onset Cancers.

PURPOSE

Survivors of adolescent and young adult (AYA)-onset cancers require comprehensive cancer surveillance care. Guidelines recommend 1-4 clinician visits annually for 5 years depending on stage and disease. The goal of this study was to identify factors associated with patterns of post-treatment primary and oncology care in a large cohort of survivors of AYA-onset cancers diagnosed within an integrated health care system.

METHODS

Patients diagnosed with cancer between 2006 and 2020 age 15-39 years were included. Surveillance visits were identified from electronic medical records 2-5 years after diagnosis. Multivariable logistic regression was used to assess associations with zero oncology specialty visits.

RESULTS

Of 7,925 survivors, 46% were Hispanic, 6% non-Hispanic Black, 11% non-Hispanic Asian, 35% non-Hispanic White, and 65% female. One-quarter had no oncology specialty visits in the first surveillance year rising to 38% in year 5; 31% had 3+ visits in the first year, declining to 13% in year 5. Over the surveillance period, 17% did not have any oncology specialty visits and 6% had no primary care or oncology visits. Those who were male (odds ratio [OR], 1.21 [95% CI, 1.02 to 1.45]), 20-24 years at diagnosis (OR, 1.58, 95% CI, 1.27 to 1.9; 35 to 39), or non-Hispanic Black (OR, 1.38, 95% CI, 1.05 to 1.82; non-Hispanic White) or had high-deductible commercial or Medicaid insurance (OR, 1.35, 95% CI, 1.15 to 1.59; OR, 1.42, 95% CI, 1.11 to 1.82, respectively; no or low deductible commercial) were more likely to be in the 0-visit group for oncology specialty care.

CONCLUSION

Although the majority of this cohort received either primary or oncology specialty care, our study identifies those who may need tailored outreach for follow-up care. Continued research into development and testing of interventions to improve uptake of appropriate health care for survivors of AYA-onset cancers is critical.