title: Identifying Predictors of Longitudinal Decline in the Level of Medical Care Received by Adult Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer.
  
  
  METHODS
  The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer.
  
  
  METHODS
  Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care.
  
  
  METHODS
  There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up.
  
  
  RESULTS
  Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤ high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for <high school and high school, respectively) were associated with no care at follow-up. Survivors with severe or life-threatening conditions at baseline (RR 0.5; 95 percent CI 0.3-0.6) were less likely to report no care at follow-up.
  
  
  CONCLUSIONS
  While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.
authors.affiliation: Department of Pediatrics, University of California, Los Angeles, CA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Casillas
authors.affiliation: Department of Medicine and Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.affiliation: Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Yeazel
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.affiliation: The University of Chicago Medicine Comer Children's Hospital, Chicago, IL.
authors.forename: Tara O
authors.initials: TO
authors.lastname: Henderson
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Cancer Prevention and Biostatistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Childhood cancer survivors; delivery of health care; health care access; health insurance; survivorship