title: Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer.
abstract: BACKGROUND
  Health care outcomes for long-term survivors of adolescent and young adult (AYA) cancer were compared with young adults without a cancer history, using the 2009 Behavioral Risk Factor Surveillance System data.
  
  
  METHODS
  Eligible participants were 20 to 39 years of age. There were N = 979 who self-reported a cancer diagnosis between the ages of 15 to 34 years and were at least 5 years from diagnosis (excluding nonmelanoma skin cancer). The remaining 67,216 participants with no cancer history were used as controls. Using multivariable regressions, relative risks and 95% confidence intervals were generated to examine the relationship of survivor status on indicators of poor health care (uninsured, no personal health care provider, no routine care, and avoiding seeing a doctor due to cost). Adjusted proportions were calculated by demographic groups. Results are weighted by Behavioral Risk Factor Surveillance System survey design.
  
  
  RESULTS
  Although the proportion uninsured did not differ (21% of survivors vs 23% of controls), AYA survivors reported forgoing care due to cost at higher levels than controls (relative risk = 1.67, 95% CI = 1.44-1.94). Cost barriers were particularly high for survivors aged 20 to 29 years (44% vs 16% of controls; P < .001) and female survivors (35% vs 18% of controls; P < .001). Survivors reporting poorer health had more cost barriers. Moreover, uninsured survivors tended to report lower use of health care than did controls.
  
  
  CONCLUSIONS
  AYA cancer survivors may forgo health care due to cost barriers, potentially inhibiting the early detection of late effects. Expanding health insurance coverage for young cancer survivors may be insufficient without adequate strategies to reduce their medical cost burdens.
authors.affiliation: Center for Children's Cancer Research, Huntsman Cancer Institute, Salt Lake City, Utah 84112, USA. anne.kirchhoff@hci.utah.edu
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Mark
authors.initials: M
authors.lastname: Fluchel
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wright
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D017741:Survivors; D055815:Young Adult