Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities

Baedke, Jessica L.; Lindsey, Lauren; James, Aimee S.; Huang, I‐Chan; Ness, Kirsten K.; Howell, Carrie R.; Brinkman, Tara M.; Bhakta, Nickhill; Ehrhardt, Matthew J.; Im, Cindy; Letsou, William; Liu, Qi; Robison, Leslie L.; Hudson, Melissa M.; Yasui, Yutaka

doi:10.1007/s11764-021-01061-3

Cited by 9 publications

(18 citation statements)

References 29 publications

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“…Our finding that a quarter of CCS reported healthcare cost barriers corroborates Beadke et al (24.8% forgoing needed medical care due to finances). 8 In our study, the proportions of having a checkup (63.6%) and an influenza vaccine (34.6%) among CCS agreed with previous studies. 6,15 Our finding that the proportions having a checkup and an influenza vaccination were similar for survivors and controls indicates equal access to primary care between the two groups.…”

Section: Discussionsupporting

confidence: 91%

“…7 Baedke et al using the St. Jude Life data found that a quarter of CCS (24.8%, 985/3,964) reported "forgoing needed medical care in the last year due to finances." 8 This study accounted for age, sex, treatment era, treatment type, primary cancer types, and self-reported health perceptions. There are additional factors that may be related to forgone needed medical care but were not addressed in previous studies.…”

Section: Introductionmentioning

confidence: 99%

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Healthcare utilization and cost barriers among U.S. childhood cancer survivors

Nghiem

Alanaeme

Mennemeyer

et al. 2023

Pediatric Blood & Cancer

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Healthcare utilization and cost barriers among U.S. childhood cancer survivors

Nghiem

Alanaeme

Mennemeyer

et al. 2023

Pediatric Blood & Cancer

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“…Attrition to follow-up is well recognized in survivors of childhood cancer, with major predictors being increasing duration from treatment, lack of medical late effects, lower socioeconomic status, longer distance from residence, and lower medical insurance. [7][8][9] Higher outof-pocket expenditures costs in adult CCS are known to adversely influence health seeking behaviors. 7,10 The financial burden of treatment is especially pertinent in low-middle income country (LMIC) settings and needs to be addressed urgently either by decentralization of care or by offering travel reimbursements, facilities for shortterm stay, and other concessions.…”

Section: Barriers To Long-term Follow-up In Adolescent and Young Adul...mentioning

confidence: 99%

Barriers to long‐term follow‐up in adolescent and young adult survivors of childhood cancer: Perspectives from a low–middle income setting

Prasad

Goswami

2021

Pediatric Blood & Cancer

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“…Health insurance status also affects careseeking behaviors, as evidenced in a study that reported that uninsured childhood cancer survivors had a high risk of forgoing care regardless of sociodemographic background. 10 Rural residents were found to have later-stage cancer at diagnosis and a lower survival rate compared with those living in metropolitan areas. 11 The association of socioeconomic status (SES) with cancer outcomes, including pediatric cancer, has also been recognized.…”

Section: Introductionmentioning

confidence: 99%

“…A review by Beltrami et al demonstrated that racial, ethnic, and socioeconomic disparities in pediatric cancer outcomes exist across disease types. Health insurance status also affects care-seeking behaviors, as evidenced in a study that reported that uninsured childhood cancer survivors had a high risk of forgoing care regardless of sociodemographic background . Rural residents were found to have later-stage cancer at diagnosis and a lower survival rate compared with those living in metropolitan areas …”

Section: Introductionmentioning

confidence: 99%

Geographic Access to Pediatric Cancer Care in the US

et al. 2023

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ImportanceAlthough access to pediatric cancer care has implications for use of such care and patient outcomes, little is known about the geographic accessibility of pediatric cancer care and how it may vary by population characteristics across the continental US.ObjectiveTo estimate the travel time to pediatric cancer care settings in the continental US, identify potential disparities among subgroups of children and adolescents and young adults (AYAs), and identify areas needing improved access to pediatric cancer care.Design, Setting, and ParticipantsThis cross-sectional study collected data from August 1 to December 1, 2021. Pediatric oncologists’ service locations in 2021 served as the pediatric cancer care settings, data for which were scraped from 2 websites containing information about health professionals. Demographic characteristics for younger children and AYAs aged 0 to 21 years were obtained from the 2015 to 2019 American Community Survey 5-year estimates. Data were analyzed from January 1 to April 31, 2022.Main Outcomes and MeasuresThe main outcome was the travel time from geographic centroids of zip code tabulation areas to the nearest pediatric oncologist. The median (IQR) travel times for each demographic subgroup were estimated. Per capita pediatric oncologist supply was calculated by dividing the total number of pediatric oncologists for each state or US Census division by its population.ResultsOf the 90 498 890 children and AYAs included in the study, 63.6% were estimated to travel less than 30 minutes and 19.7% to travel between 30 and 60 minutes (for a total of 83.3%) to the nearest pediatric oncologist. Median (IQR) travel times were longest for the American Indian or Alaska Native pediatric population (46 [16-104] minutes) and residents of rural areas (95 [68-135] minutes), areas with high deprivation levels (36 [13-72] minutes), and the South (24 [13-47] minutes) and Midwest (22 [11-51] minutes) compared with the general population of children and AYAs. The pediatric oncologist supply was lowest in Wyoming (0 oncologists per 100 000 pediatric population) and highest in Washington, DC (53.3 oncologists per 100 000 pediatric population). Pediatric oncologist supply across Census divisions was lowest in the Mountain division (3.3 oncologists per 100 000 pediatric population) and highest in the New England division (8.1 oncologists per 100 000 pediatric population).Conclusions and RelevanceResults of this study showed that most children and AYAs in the continental US had adequate access to pediatric cancer care, although disparities existed among racial and ethnic groups and residents in rural areas, areas with high deprivation levels, and some Southern and Midwestern states. Reducing these disparities may require innovative approaches, such as expanding the capabilities of local facilities and creating partnerships with adult oncology centers and primary care physicians.

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Forgoing needed medical care among long-term survivors of childhood cancer: racial/ethnic-insurance disparities

Cited by 9 publications

References 29 publications

Healthcare utilization and cost barriers among U.S. childhood cancer survivors

Healthcare utilization and cost barriers among U.S. childhood cancer survivors

Barriers to long‐term follow‐up in adolescent and young adult survivors of childhood cancer: Perspectives from a low–middle income setting

Geographic Access to Pediatric Cancer Care in the US

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