title: Need and Use of Healthcare Services in Survivors of Hodgkin Lymphoma.
abstract: Hodgkin lymphoma (HL) is the commonest cancer in adolescents and young adults (AYAs), aged 15-29 years. While the survival rate is high, many survivors experience adverse late effects of therapy. Yet, this age group in general makes limited use of health services. This study sought to determine whether the need for health services by HL survivors was mismatched to their health service utilization, as hypothesized a priori.
  
  
  
  A population-based cohort of survivors (N = 43) younger than 39 years of age was sent a mailed survey for self-assessment of need, as expressed in health-related quality of life (HRQOL), and utilization of health services by validated instruments; the Health Utilities Index and Health and Social Service Utilization Survey, respectively. Survivors who were AYAs at diagnosis were compared to children and older adults.
  
  
  
  AYAs had the lowest mean HRQOL score (0.79 on a scale of 0.00-1.00) compared to children (0.86) and older adults (0.94)-clinically meaningful differences. The difference in the single attribute score for cognition reached statistical significance (0.89 vs. 0.99 vs. 1.00, p = 0.02). AYAs also had lower mean overall annual costs for health services (CAN$601) than children (CAN$753) and older adults (CAN$936) did.
  
  
  
  Survivors of HL who were AYAs at diagnosis had a mismatch between high need for and low utilization of health services. Providers of healthcare to this population should be made aware of this discrepancy, and the survivors should be encouraged to seek the health services they need.
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada .
authors.forename: Charlene
authors.initials: C
authors.lastname: Rae
authors.affiliation: 2 Hematology Site Team, Juravinski Cancer Centre , Hamilton, Canada .
authors.forename: Ann
authors.initials: A
authors.lastname: Benger
authors.affiliation: 3 Service of Hematology-Oncology, McMaster Children's Hospital , Hamilton, Canada .
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Fowler
authors.affiliation: 4 Hematology Site Team, Grand River Cancer Centre , Kitchener, Canada .
authors.forename: Janet
authors.initials: J
authors.lastname: MacEachern
authors.affiliation: 5 Child Health Evaluative Sciences, Hospital for Sick Children , Toronto, Canada .
authors.forename: Eleanor
authors.initials: E
authors.lastname: Pullenayegum
authors.affiliation: 1 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada .
authors.forename: Michelle
authors.initials: M
authors.lastname: Stryker
authors.affiliation: 3 Service of Hematology-Oncology, McMaster Children's Hospital , Hamilton, Canada .|6 Department of Pediatrics, McMaster University , Hamilton, Canada .
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006296:Health Services / Q000592:standards*; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D017741:Survivors; D055815:Young Adult
keywords: Hodgkin lymphoma; health-related quality of life; healthcare utilization; survivorship