Predictors of health care utilization in adult survivors of childhood cancer exposed to central nervous system-directed therapy.
BACKGROUND
Survivors of childhood cancer treated with central nervous system (CNS)-directed therapy may be at risk for poor health care utilization because of neurocognitive deficits. This study examined associations between neurocognitive function and adherence to routine and risk-based medical evaluations in adult survivors exposed to CNS-directed therapy.


METHODS
Neurocognitive function and health care utilization were assessed in 1304 adult survivors of childhood cancer enrolled in the St. Jude Lifetime Cohort Study. Adherence to recommended care was defined as meeting guidelines published by the Children's Oncology Group. Multivariate models were used to evaluate associations between neurocognitive function and health screenings. Established predictors of health care utilization were included as covariates. Odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for variables maintained in the final models.


RESULTS
Adherence to recommended medical care was higher for routine care (general physician care, 57.6%; dental care, 49.1%) versus specialized care (survivor-focused care, 21.9%; echocardiogram, 19.9%). Higher intelligence was predictive of general physician care (OR, 1.74; 95% CI, 1.41-2.15) and survivor-focused care (OR, 1.44; 95% CI, 1.13-1.83) in comparison with no care, whereas better executive function skills were associated with reduced dental care (PR, 0.94; 95% CI, 0.91-0.98). Echocardiogram monitoring was not associated with neurocognition. Possible late effects of cancer treatment (pain and reduced cardiorespiratory fitness) were associated with an increased likelihood of receiving specialized medical care.


CONCLUSIONS
Survivors with reduced global cognition are at risk for poor health care utilization. Educational practices regarding recommended health care should be personalized to ensure comprehension by survivors with neurocognitive impairment.
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cara I
CI
Kimberg
James L
JL
Klosky
Nan
N
Zhang
Tara M
TM
Brinkman
Kirsten K
KK
Ness
Deo Kumar
DK
Srivastava
Leslie L
LL
Robison
Melissa M
MM
Hudson
Kevin R
KR
Krull
D000293:Adolescent; D000328:Adult; D002490:Central Nervous System; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000523:psychology*; D003729:Dental Care / Q000706:statistics & numerical data*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006304:Health Status; D006801:Humans; D007360:Intelligence / Q000502:physiology; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
childhood cancer; health care utilization; late effects; long-term survivors; neurocognition