Identifying predictors of longitudinal decline in the level of medical care received by adult survivors of childhood cancer: A report from the childhood cancer survivor study

Objectives Characterize longitudinal changes in the use of medical care in adult survivors of childhood cancer. Data Sources The Childhood Cancer Survivor Study, a retrospective cohort study of 5+ year survivors of childhood cancer. Study Design Medical care was assessed at entry into the cohort (baseline) and at most recent questionnaire completion. Care at each time point was classified as no care, general care, or survivor-focused care. Data Collection There were 6,176 eligible survivors. Multivariable models evaluated risk factors for reporting survivor-focused care or general medical care at baseline and no care at follow-up; and survivor-focused care at baseline and general care at follow-up. Principal Findings Males (RR, 2.3; 95 percent CI 1.8-2.9), earning <$20,000/year (RR, 1.6; 95 percent CI 1.2-2.3) or ≤high school education (RR, 2.5; 95 percent CI 1.6-3.8 and RR 2.0; 95 percent CI 1.5-2.7 for <high school and high school, respectively) were associated with no care at follow-up. Survivors with severe or life-threatening conditions at baseline (RR 0.5; 95 percent CI 0.3-0.6) were less likely to report no care at follow-up. Conclusions While the incidence of late effects increases over time for survivors, the likelihood of receiving survivor-focused care decreases for vulnerable populations.