Rethinking Adherence: A Proposal for a New Approach to Risk Assessment

Rosenberg, Abby R.; Macpherson, Catherine Fiona; Kroon, Leah; Johnson, Rebecca H.

doi:10.1089/jayao.2012.0025

Cited by 13 publications

(23 citation statements)

References 32 publications

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“…Patients with lower disease stages may be disproportionately affected, perhaps because of perceptions that their risks of complications or recurrence are lower. Likewise, ongoing contact with health care providers may encourage better adherence to treatment and follow‐up guidelines, factors that have been associated previously with poor outcomes among AYAs …”

Section: Discussionmentioning

confidence: 99%

Insurance status and risk of cancer mortality among adolescents and young adults

Rosenberg

Kroon

Chen

et al. 2014

Cancer

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141

133

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BACKGROUND Adolescents and young adults with cancer have inferior survival outcomes compared with younger pediatric patients and older adult patients. Lack of insurance may partly explain this disparity. The objective of this study was to identify associations between insurance status and both advanced-stage cancer and cancer-specific mortality. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) 18 registries, 57,981 patients ages 15 to 39 years were identified who were diagnosed between 2007 and 2010 and had complete insurance and staging information. Multinomial logistic regression models were used to identify associations between insurance type and disease stage, with the models adjusted for sex, age, and race. Cox proportional hazards models were used to estimate cancer-specific mortality. RESULTS Overall, 84% of patients were aged ≥25 years, 64% were women, and 79% were privately insured. Compared with patients who had private insurance, those who had nonprivate insurance tended to present with more advanced-stage disease and to die more quickly and more commonly from their cancer. Patients ages 25 to 39 years who had Medicaid coverage or no insurance had 3.2 times and 2.4 times higher odds of having stage IV disease, respectively, than privately insured patients (95% confidence interval [CI], 3.0–3.5 times higher odds and 2.1–2.6 times higher odds, respectively). Among those with stage I/II and III/IV cancers, the risk of death was 2.9 times greater (95% CI, 2.2–3.9 times greater) and 1.7 times greater (95% CI, 1.5–1.9 times greater), respectively, than the risk for privately insured patients. Patients who died from stage III/IV cancers survived at least 2 months longer if they had private insurance. CONCLUSIONS Among young adults, insurance status is independently associated with advanced-stage cancer and the risk of death from cancer, even for patients who have low-stage disease. Broader insurance coverage and access to health care may improve some of the disparate outcomes of adolescents and young adults with cancer.

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Section: Discussionmentioning

confidence: 99%

Insurance status and risk of cancer mortality among adolescents and young adults

Rosenberg

Kroon

Chen

et al. 2014

Cancer

Self Cite

141

133

View full text Add to dashboard Cite

show abstract

“…For example, after treatment, a brief strengths‐based case‐management intervention targeting health care SE/activation and post‐traumatic growth may provide a motivating narrative for CCS to engage in cancer‐related follow‐up care. Developing these and other tailored interventions based on patient resources/characteristics for long‐term engagement with care may mitigate subsequent declines in follow‐up care …”

Section: Discussionmentioning

confidence: 99%

Cancer‐related follow‐up care among Hispanic and non‐Hispanic childhood cancer survivors: The Project Forward study

Milam

Meeske

Slaughter

et al. 2014

Cancer

113

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Background Follow-up care is critical for childhood cancer survivors (CCS) who are at high risk for co-morbidities and late effects of cancer treatments. Understanding factors associated with maintaining follow-up care is needed, especially for Hispanic CCS who are underrepresented in previous studies. Methods Risk and protective factors for receiving cancer-related follow-up care were examined among 193 Los Angeles County CCS diagnosed between 2000–2007 (54% Hispanic; mean age=19.9, SD=2.8; mean age at diagnosis=12.1, SD=3.0; mean years since diagnosis=7.8, SD=2.0). Self-report surveys assessed follow-up care, insurance status, demographics, clinical factors, and psychosocial risk (e.g., depression) and protective [e.g., self-efficacy (SE)] factors. Multivariable logistic regression was used to determine factors associated with previous (in prior 2 years) and intent for future cancer-related follow-up care. Results Seventy-three percent of CCS reported a cancer follow-up visit in the prior 2 years, which was positively associated (p’s<.05) with having health insurance, White ethnicity (vs. Hispanic), younger age and greater treatment intensity. Sixty-nine percent reported intent for follow-up care in the next two years, which was positively associated (p’s<.05) with having health insurance and greater SE. Conclusions Hispanics and older CCS are more likely to lack previous follow-up care. Because health insurance was strongly associated with both previous follow-up care and intent to seek care, recent changes in health coverage may improve follow-up among CCS. Interventions targeting improved SE may help increase intent to receive follow-up care for this population.

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“…6 Risk assessment for nonadherence among AYA patients should include consideration of patient maturity, independence, unmet psychosocial and physical needs, and treatment side effects. 75 For AYAs presumed to be at high risk of nonadherence, implementation of individualized interventions such as additional supportive care resources (eg, social work, psychology, palliative care) to promote adherence may improve outcomes. The patient's personal support system (family and friends) should be mobilized and educated to assist in relieving some of the burdens of care and to positively encourage the patient to maintain adherence to therapy.…”

Section: Adherence To Treatmentmentioning

confidence: 99%

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

Coccia¹,

Pappo²,

Beaupin³

et al. 2018

J Natl Compr Canc Netw

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253

194

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Rethinking Adherence: A Proposal for a New Approach to Risk Assessment

Cited by 13 publications

References 32 publications

Insurance status and risk of cancer mortality among adolescents and young adults

Insurance status and risk of cancer mortality among adolescents and young adults

Cancer‐related follow‐up care among Hispanic and non‐Hispanic childhood cancer survivors: The Project Forward study

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

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