title: Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer.
abstract: BACKGROUND
  Existing comorbidity indices were not developed for adolescent and young adults (AYA) 15 to 39 years of age. The aim of this study was to assess impact of comorbidities on health care service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices.
  
  
  METHODS
  Data on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities was based on the AYA HOPE index. Charlson and NCI indices were compared. Multivariable logistic regression was used.
  
  
  RESULTS
  Of the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal, and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs [OR, 2.05; 95% confidence interval (CI), 1.10-3.82] adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status.
  
  
  CONCLUSIONS
  The AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices, and the number of comorbidities is associated with service needs and health status.
  
  
  CONCLUSIONS
  The AYA HOPE index could identify patients' additional service needs early in therapy.
authors.affiliation: Department of Epidemiology, LSUHSC, New Orleans, Louisiana. xwu@lsuhsce.du.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: Department of Pediatric Hematology/Oncology, LSUSHC/Children's Hospital of New Orleans, New Orleans, Louisiana.
authors.forename: Pinki K
authors.initials: PK
authors.lastname: Prasad
authors.affiliation: Department of Epidemiology, LSUHSC, New Orleans, Louisiana.
authors.forename: Ian
authors.initials: I
authors.lastname: Landry
authors.affiliation: Applied Research Program, National Cancer Institute, Bethesda, Maryland.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, Iowa.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Smith
authors.affiliation: Preventive Medicine, University of Southern California Norris Cancer Center, Los Angeles, California.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D011788:Quality of Life; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult