Insurance coverage change and survivorship care among young adult survivors of childhood cancer

Mobley, Erin M.; Kim, Sue E.; Cousineau, Michael R.; Tsui, Jennifer; Miller, Kimberly A.; Tobin, Jessica; Freyer, David R.; Milam, Joel

doi:10.1111/1475-6773.13868

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…We screened 7945 citations for relevance, we screened 2760 publications as full text against the prespecified eligibility criteria, and we identified 22 studies (as reported in 61 individual publications) examining disparities in survivorship care for CCS 17–69 . Figure 1 presents the PRISMA flow diagram that visually depicts the number of studies that were both included and excluded at each stage of the review process and the reasons for exclusion.…”

Section: Resultsmentioning

confidence: 99%

“…We screened 7945 citations for relevance, we screened 2760 publications as full text against the prespecified eligibility criteria, and we identified 22 studies (as reported in 61 individual publications) examining disparities in survivorship care for CCS. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 Figure 1 pre...…”

Section: Resultsmentioning

confidence: 99%

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Disparities in pediatric cancer survivorship care: A systematic review

et al. 2023

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BackgroundChildhood cancer survivors (CCS) experience many long‐term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access to survivorship care nor receive recommended survivorship care. We reviewed the empirical evidence of disparities in survivorship care for CCS.MethodsThis systematic review searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS (PROSPERO: CRD42021227965) and abstracted the reported presence or absence of disparities in care. We screened 7945 citations, and of those, we reviewed 2760 publications at full text.ResultsA total of 22 studies reported in 61 publications met inclusion criteria. Potential disparities by cancer treatment (N = 14), diagnosis (N = 13), sex (N = 13), and current age (N = 13) were frequently studied. There was high quality of evidence (QOE) of survivorship care disparities associated with non‐White race, Hispanic ethnicity, and being uninsured. Moderate QOE demonstrated disparities among CCS who were unemployed and older. Lower QOE was found for disparities based on cancer diagnosis, cancer treatment, age at diagnosis, time since diagnosis, sex, insurance type, income, educational attainment, and geographic area.ConclusionsWe found strong empirical evidence of disparities in survivorship care for CCS associated with race, ethnicity, and insurance status. Multiple other disparate groups, such as those by employment, income, insurance type, education, cancer diagnosis, age at diagnosis, time since diagnosis, cancer treatment, geographic area, sex, and self‐identified gender warrant further investigation. Prospective, multilevel research is needed to examine the role of other patient characteristics as potential disparities hindering adequate survivorship care in CCS.

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Section: Resultsmentioning

confidence: 99%

“…We screened 7945 citations for relevance, we screened 2760 publications as full text against the prespecified eligibility criteria, and we identified 22 studies (as reported in 61 individual publications) examining disparities in survivorship care for CCS. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 Figure 1 pre...…”

Section: Resultsmentioning

confidence: 99%

Disparities in pediatric cancer survivorship care: A systematic review

et al. 2023

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“… 49 Any change in survivor health insurance was associated with a decreased likelihood of follow-up care attendance. 54 Survivors also identified opportunity costs from lost wages, lack of financial support, and high perceived cost of medical expenses such as screening examinations as obstacles to obtaining survivorship care.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review Exploring Access to Survivorship Care for Childhood, Adolescent, and Young Adult Cancer Survivors: How Can We Optimize Care Pathways?

McLoone,

Sansom-Daly,

Paglia

et al. 2023

AHMT

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Childhood, adolescent, and young adult (CAYA) cancer survivors are at risk of developing late effects associated with their cancer and its treatment. Survivors’ engagement with recommended follow-up care to minimize these risks is suboptimal, with many barriers commonly reported. This scoping review aims to summarize the barriers to accessing follow-up care, using the dimensions of Levesque’s framework for accessing healthcare. We retrieved quantitative studies addressing barriers and facilitators to accessing survivorship care in CAYA survivors from PubMed, EMBASE and CINAHL. Data was categorized into the five healthcare access dimensions outlined in Levesque’s framework: i) approachability, ii) acceptability, iii) availability and accommodation, iv) affordability, and v) appropriateness. We identified 27 quantitative studies in our review. Commonly reported barriers to accessing care included a lack of survivor and provider knowledge of cancer survivorship, poor health beliefs, low personal salience to engage in follow-up care, high out-of-pocket costs and survivors living long distances from clinical services. Many studies reported increased barriers to care during the transition from paediatric to adult-oriented healthcare services, including a lack of developmentally appropriate services, lack of appointment reminders, and a poorly defined transition process. Healthcare-related self-efficacy was identified as an important facilitator to accessing follow-up care. The transition from pediatric to adult-oriented healthcare services is a challenging time for childhood, adolescent, and young adult cancer survivors. Optimizing CAYAs’ ability to access high-quality survivorship care thus requires careful consideration of the quality and acceptability of services, alongside financial and physical/practical barriers (eg distance from available services, appointment-booking mechanisms). Levesque’s model highlighted several areas where evidence is well established (eg financial barriers) or lacking (eg factors associated with engagement in follow-up care) which are useful to understand barriers and facilitators that impact access to survivorship for CAYA cancer survivors, as well as guiding areas for further evaluation.

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“…Although this approach provides a reasonable scaffold for stratification, it overlooks key factors to consider in determining which patients may benefit from more frequent interaction with the survivorship care team at the cancer center to support their access to services and resources versus follow-up in a community setting. 106,107 For example, socioeconomic (eg, insurance status) 108,109 and geographic (eg, distance from care) constraints 110,111 may preclude access to specialized providers to address cancer treatment-related toxicities uncommonly encountered in primary care settings. In addition, the burden of CHCs (total number and severity) 112 and the impact of individual CHCs on self-reported daily functioning (ie, health-related quality of life) may challenge identification of community providers comfortable caring for survivors with medically complex needs.…”

Section: Risk-stratified Approaches To Carementioning

confidence: 99%

Health Care Transitions Among Adolescents and Young Adults With Cancer

Ehrhardt,

Friedman,

Hudson

2024

JCO

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Survivors of adolescent and young adult (AYA) cancers, defined as individuals diagnosed with a primary malignancy between age 15 and 39 years, are a growing population with unique developmental, psychosocial, and health-related needs. These individuals are at excess risk of developing a wide range of chronic comorbidities compared with the general population and, therefore, require lifelong, risk-based, survivorship care to optimize long-term health outcomes. The health care needs of survivors of AYA cancers are particularly complicated given the often heterogeneous and sometimes fragmented care they receive throughout the cancer care continuum. For example, AYA survivors are often treated in disparate settings (pediatric v adult) on dissimilar protocols that include different recommendations for longitudinal follow-up. Specialized tools and techniques are needed to ensure that AYA survivors move seamlessly from acute cancer care to survivorship care and, in many cases, from pediatric to adult clinics while still remaining engaged in long-term follow-up. Systematic, age-appropriate transitional practices involving well-established clinical models of care, survivorship care plans, and survivorship guidelines are needed to facilitate effective transitions between providers. Future studies are necessary to enhance and optimize the clinical effectiveness of transition processes in AYA cancer survivors.

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Insurance coverage change and survivorship care among young adult survivors of childhood cancer

Cited by 6 publications

References 39 publications

Disparities in pediatric cancer survivorship care: A systematic review

Disparities in pediatric cancer survivorship care: A systematic review

A Scoping Review Exploring Access to Survivorship Care for Childhood, Adolescent, and Young Adult Cancer Survivors: How Can We Optimize Care Pathways?

Health Care Transitions Among Adolescents and Young Adults With Cancer

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