title: Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance.
  
  
  CONCLUSIONS
  Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.
authors.affiliation: Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA, theresa.keegan@cpic.org.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.forename: Li
authors.initials: L
authors.lastname: Tao
authors.forename: Mindy C
authors.initials: MC
authors.lastname: DeRouen
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.forename: Pinki
authors.initials: P
authors.lastname: Prasad
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Zebrack
authors.forename: Roland
authors.initials: R
authors.lastname: Chu
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Smith
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D017741:Survivors; D055815:Young Adult