Medical care in adolescents and young adult cancer survivors: What are the biggest access-related barriers?

Theresa H M Keegan, Li Tao, Mindy C. DeRouen, Xiao Cheng Wu, Pinki Prasad, Charles F. Lynch, Margarett Shnorhavorian, Brad J. Zebrack, Roland Chu, Linda C. Harlan, Ashley W. Smith, Helen M. Parsons

Research output: Contribution to journalArticlepeer-review

73 Scopus citations


Purpose: Adolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored. Methods: We studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used. Results: Most AYA cancer survivors (95 %), who were 15-35 months post diagnosis, received medical care in the past 12 months and 17 % were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95 % confidence interval (CI) = 1.7-13.8) or have had health insurance in the past year (OR = 4.0; 95 % CI = 0.99-16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25 % of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys. Conclusion: AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance. Implications for Cancer Survivors: Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.

Original languageEnglish (US)
Pages (from-to)282-292
Number of pages11
JournalJournal of Cancer Survivorship
Issue number2
StatePublished - Jun 2014

Bibliographical note

Funding Information:
L.C.Harlan . A. W. Smith Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

Funding Information:
Acknowledgments This study was supported by the National Cancer Institute contracts N01-PC-54402, N01-PC-54404, N01-PC-35136, N01-PC-35139, N01-PC-35142, N01-PC-35143, and N01-PC-35145. Dr. Parsons was supported by a National Cancer Institute Cancer Prevention and Control Career Development Award (K07CA175063).


  • Adolescent and young adult
  • Cancer care
  • Cancer survivors
  • Health insurance


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