title: Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  We wanted to determine the type of outpatient medical care reported by young adult survivors of childhood cancer and to examine factors associated with limited medical care.
  
  
  METHODS
  We analyzed data from 9,434 adult childhood cancer survivors enrolled in a retrospective cohort study who completed a baseline questionnaire. They had a mean age of 26.8 years (range 18 to 48 years), 47% were female, 12% were minorities, and 16% were uninsured. Four self-reported outcome measures were used to determine outpatient medical care in a 2-year period: general contact with the health care system, general physical examination, cancer-related medical visit, and medical visit at a cancer center.
  
  
  RESULTS
  Eighty-seven percent reported general medical contact, 71.4% a general physical examination, 41.9% a cancer-related visit, and 19.2%, a visit at a cancer center. Factors associated with not reporting a general physical examination, a cancer-related visit, or a cancer center visit included no health insurance (odds ratio [OR] = 2.34; 95% confidence interval [CI], 1.97-2.77), male sex (OR = 1.65; 95% CI, 1.44-1.88), lack of concern for future health (OR = 1.57; 95% CI, 1.36-1.82), and age 30 years or older in comparison with those 18 to 29 years (OR = 1.56; 95% CI, 1.35-1.81). The likelihood of reporting a cancer-related visit or a general physical examination decreased significantly as the survivor aged or the time from cancer diagnosis increased. This trend was also significant for those treated with therapies associated with substantial risk for cardiovascular disease or breast cancer.
  
  
  CONCLUSIONS
  Primary care physicians provide health care for most of this growing high-risk population. To optimize risk-based care, it is critical that cancer centers and primary care physicians develop methods to communicate effectively and longitudinally.
authors.affiliation: Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center, Dallas, Tex 75390-9067, USA. kevin.oeffinger@utsouthwestern.edu
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Casillas
authors.forename: Hegang
authors.initials: H
authors.lastname: Chen
authors.forename: John
authors.initials: J
authors.lastname: Whitton
authors.forename: Mark
authors.initials: M
authors.lastname: Yeazel
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data*; D000704:Analysis of Variance; D002170:Canada; D002173:Cancer Care Facilities; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005194:Family Practice; D005260:Female; D006801:Humans; D007373:Interinstitutional Relations; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D010342:Patient Acceptance of Health Care; D012306:Risk; D017741:Survivors; D014481:United States