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) 15–39 years of age. The aim of this study was to assess impact of comorbidities on healthcare 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 based on the AYA HOPE index. Charlson and NCI indices) were compared. Multivariable logistic regression was employed. 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% CI 1.10–3.82) adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status. Conclusion 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. Impact The AYA HOPE index could identify patients’ additional service needs early in therapy.

Understanding care and outcomes in adolescents and young adults with cancer: A review of the AYA HOPE study

“…Unmarried patients reported worse mental health. Other areas that influenced HRQOL outcomes included comorbidities (for which an index tailored to this age group was developed), unmet service needs, and negative perceptions of control over their lives . Overall, our findings suggest that subgroups of AYA patients with cancer experience major decrements in several physical and mental HRQOL domains.…”

“…Recent European research has also shown a dearth of available AYA‐focused supportive care . In AYA HOPE, factors associated with unmet services included having two or more comorbidities and reporting any physical symptoms . Unmet service needs were also associated with worse mental, physical, and overall HRQOL .…”

Polypharmacy and patterns of prescription medication use among cancer survivors

“…AYA patients often receive fragmented care as they are caught between pediatric and adult oncology, perhaps increasing the likelihood of polypharmacy and multiple prescribing physicians. Compared with older cancer survivors, AYA cancers survivors have earlier onset chronic conditions that accumulate over the life course . Many AYA survivors report unmet health care needs, particularly for the late effects of treatment, mental health, weight management, and pain management .…”

“…Compared with older cancer survivors, AYA cancers survivors have earlier onset chronic conditions that accumulate over the life course . Many AYA survivors report unmet health care needs, particularly for the late effects of treatment, mental health, weight management, and pain management . Financial challenges also may compromise adherence to multiple prescription regimens .…”

Zurück in die Zukunft

“…Zum einen ist die durchschnittliche Prognose bei Krebs in diesem Alter überdurchschnittlich gut, andererseits bleiben AYA-Krebs-Patienten im Unterschied zu älteren Erwachsenen noch auf Jahrzehnte mit den weitreichenden Folgen der Krebsdiagnose und -behandlung konfrontiert (3)(4)(5)(6)(7)(8)(9)(10). Diese lebenslange Erfahrung wird als ein kontrastreiches Lebensgefühl, weil grundsätzlich verschieden und mit einer erhöhten Vulnerabilität für körperliche und psychosoziale Spätkomplikationen behaftet, im Vergleich zu dem Lebensgefühl der "gesunden" Gleichaltrigen empfunden (11)(12)(13)(14)(15). "Ich bin jetzt 28, habe ein Kind und eine eigene Familie.…”