Abstract IA039: Individual, cultural, and area-based factors associated with survivorship care among Asian American childhood cancer survivors
Authors: Miller Kimberly A. 
Published: December 2023

Abstract
With treatment advances for childhood cancer, over 80% of patients achieve long-term survival. However, cancer treatments often lead to serious issues, including chronic health problems and early mortality. As a result, life-long cancer-focused long-term follow-up care (LTFU) is essential for childhood cancer survivors (CCS) to screen for, prevent, and treat late effects. Among Asian Americans, who represent the fastest growing ethnic group and the largest group of new immigrants in the United States, rates of LTFU and factors influencing cancer-focused care among CCS are unknown. To address this research gap, we are currently recruiting a population-based cohort of roughly 330 young adult Asian American CCS and their parents in Los Angeles and Orange Counties, California, to examine individual, cultural, and area-level factors (e.g., impacts of residence in an ethnically concentrated neighborhood or “ethnic enclave”) related to survivorship care utilization. Our preliminary data from the Project Forward cohort, a cancer registry–derived, population-based study of risk and protective factors of cancer-related follow-up care among young adult CCS Indicated lower rates of LTFU among Asian American (versus other racial and ethnic groups) and was lowest for non-US-born Asian American CCS (45.8% compared to 62% non-Latino white). To better understand the potential role of neighborhood level enclave in LTFU, we examined all cancer cases of Asian race/ethnicity ages 18-39, living in Los Angeles or Orange County, California, diagnosed while under age 21 in the years 1991-2018 (N=743). Focusing on the most common subgroups (Chinese, Korean, Vietnamese, and Filipino), we were able to identify distinct clusters of residential enclave neighborhoods for each subgroup. We then linked cases via their census tract of residence to American Community Survey data to examine factors associated with LTFU among CCS. For all Asian subgroups, the proportion of non-US born individuals was higher inside the enclave than outside, as was the proportion of individuals reporting they speak English “less than very well.” In addition, the direction of the differences varied in potential LTFU-related factors by enclave status and Asian subgroup: for example, Koreans residing inside a Korean enclave were more likely to have access to a vehicle while Filipinos living inside Filipino enclaves were more likely to not have vehicle access (in both cases, versus those residing outside enclaves). Thus, factors related to enclave residence may have unique positive and negative associations with LTFU. Overall, understanding the dynamics of individual, cultural, and enclave-related factors will help identify methods to increase culturally congruent outreach and intervention strategies to promote LTFU for Asian American CCS.
Citation Format: Kimberly A. Miller. Individual, cultural, and area-based factors associated with survivorship care among Asian American childhood cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA039.