title: Healthcare Utilization Among Young Adult Survivors of Childhood Cancer in Canada: The Role of Patient-Level Factors
Creators: name: Drummond, Rachelle Marie
Publisher: name: Graduate Studies
Year: 2024
Subjects: subject: Cancer
subject: Childhood cancer
subject: Young adult
subject: Survivor of childhood cancer
subject: Healthcare utilization
subject: Education--Health
subject: Oncology

description: Background: Survivors of childhood cancer (SCC) face substantive risks for developing late effects (LE) from their cancer treatments due to disruptions in crucial periods of physical and social development while undergoing cancer treatment (Tonorezos et al., 2022; Baker &amp; Syrjala, 2018). The inappropriate use of healthcare services, whether underutilization or overutilization, may jeopardize the effective risk-based prevention and management of LE among SCC. In addition, inappropriate healthcare utilization (HCU) may contribute to unsustainability and inefficiency in the healthcare system, creating challenges for supporting the growing population of survivors in Canada. Despite existing knowledge that young adult (YA) SCC are at a heightened high risk for the development of LE and life-long complications from their treatments, limited research exists that describes HCU among this population. The two aims of this study were to 1) identify and explore the associations of survivor’s demographics (i.e., sex, gender, age, race, geographic location, SES), knowledge of cancer history and risks, and psychological factors (i.e., anxiety, depression) and perceived vulnerability with healthcare utilization; and 2) examine the relationships among demographic, clinical, and psychological patient-level factors with HCU among YA SCC. Methods: Canadian YA SCC (n=123; 31% male; mean age=28.19yrs, mean time post treatment= 16.56yrs) diagnosed &lt;18 years of age; and &gt;5 years from diagnosis and/or &gt;2 years from treatment completed the Self-Report Survey of Cancer Knowledge (Kunin-Batson et al., 2016), and the Self-Report Survey of Core Health Beliefs (Tercyak et al., 2004), to assess knowledge of cancer history and risks and perceived vulnerability, respectively. Survivors completed the Patient-Reported Outcomes Measurement Information System (PROMIS) SF v1.0 Anxiety 8a and the PROMIS SF v1.0 Depression 8a to assess levels of anxiety and depression respectively. To assess HCU, survivors reported the number of times that they saw a doctor within the last 2 years, in relation to their cancer diagnosis. A bivariate logistic regression model examined associations between YA SCC’s demographics, knowledge of cancer history, and psychological factors with HCU. Results: Survivors reported a wide range of HCU rates over the past 2 years (median= 3-4 visits). The number of reported visits ranged from 0-20+ visits. Despite 45.5% of reported health problems being attributed to mental health, psychiatrists and psychologists/counselors were the third and fourth least utilized types of providers, respectively. A logistic regression model was conducted to assess the associations between HCU and patient-related factors. The model was significant X2(8) =23.68, p=0.003, and accounted for 29.3% of variance in healthcare utilization among YA SCC (NagelKerke R2= 0.293). Anxiety was the only independent variable that contributed significantly to the model (p&lt;0.001), and higher anxiety scores were associated with increased odds of HCU. Conclusion: Anxiety levels were a significant predictor of HCU rates within this population, whereby higher anxiety scores were associated with higher HCU rates. Based on the findings of this study, behavioral interventions could be beneficial in reducing anxiety among YA SCC and promoting appropriate risk based HCU that support the long-term well-being of survivors, and the sustainability of the healthcare system.