Use of health care services by survivors of childhood and adolescent cancer in Canada.
BACKGROUND
The number of survivors of childhood cancer in Canada is growing. The large majority of survivors experience at least 1 adverse late effect of their cancer therapy, which often becomes more severe and clinically apparent with time. The extent of survivors' use of health services in Canada is unknown, although coordinated, continuous, long-term follow-up care has been recommended by numerous investigators.


METHODS
Information on reported consultations with healthcare practitioners in the past year was obtained from 2152 survivors of child and adolescent cancer (mean age at diagnosis, 7.3; range, 0-19) and 2432 age- and sex-matched population-based controls through a mailed questionnaire.


RESULTS
Similar proportions of survivors (71%) and controls (73%) reported consulting a general practitioner in the past year. Survivors were more likely than controls to consult with any specialist (68% vs. 46%), including an oncologist (29% vs. 0.3%). Survivors' consultations with oncologists increased with concurrent physical health problems (adjusted odds ratio [OR(adj)], 1.7, 95% confidence interval [CI], 1.4-2.1), history of high risk therapy (OR(adj), 2.4, 95% CI, 1.9-2.9), and multiple treatment series (OR(adj), 2.2, 95% CI, 1.7- 3.0), but decreased with time since diagnosis (OR(adj), 0.3, 95% CI, 0.2-0.4).


CONCLUSIONS
Although most survivors reported consulting with at least 1 healthcare practitioner in the past year, the large majority did not report consulting an oncologist and thus may not be receiving optimal follow-up care. Moreover, consultations decreased with time since diagnosis, exactly when risk of late effects increases. This limited preventive care could have major implications on survivors' long-term health.
Shaw
Amanda K
AK
Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada. amanda_shaw@phac-aspc.gc.ca
Pogany
Lisa
L
Speechley
Kathy N
KN
Maunsell
Elizabeth
E
Barrera
Maru
M
Mery
Leslie S
LS
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data; D000328:Adult; D002170:Canada; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy; D011795:Surveys and Questionnaires; D017741:Survivors