Use of health care services by survivors of childhood and adolescent cancer in Canada

Authors

  • Amanda K. Shaw M.Sc.,

    Corresponding author
    1. Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
    • Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, 120 Colonnade Rd, AL: 6702A, Ottawa, Ontario K1A 0K9, Canada
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    • Fax: (613) 941-5497

  • Lisa Pogany M.Sc.,

    1. Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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  • Kathy N. Speechley Ph.D.,

    1. Departments of Paediatrics and Epidemiology & Biostatistics, The University of Western Ontario and Children's Health Research Institute, London, Ontario, Canada
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  • Elizabeth Maunsell Ph.D.,

    1. Population Health Research Unit, Department of Social and Preventive Medicine, Universite Laval, Quebec, Canada
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    • E. Maunsell was an NHRDP National Health Research Scholar when this study began and is currently an Investigator of the Canadian Institutes of Health Research / Social Sciences and Humanities Research Council / National Health Research and Development Program (CIHR/SSHRC/NHDRP) program for social research in health.

  • Maru Barrera Ph.D.,

    1. Department of Psychology, Haematology / Oncology Program, Hospital for Sick Children and Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
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  • Leslie S. Mery M.Sc.

    1. Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Abstract

BACKGROUND

The number of survivors of childhood cancer in Canada is growing. The large majority of survivors experience at least 1 adverse late effect of their cancer therapy, which often becomes more severe and clinically apparent with time. The extent of survivors' use of health services in Canada is unknown, although coordinated, continuous, long-term follow-up care has been recommended by numerous investigators.

METHODS

Information on reported consultations with healthcare practitioners in the past year was obtained from 2152 survivors of child and adolescent cancer (mean age at diagnosis, 7.3; range, 0-19) and 2432 age- and sex-matched population-based controls through a mailed questionnaire.

RESULTS

Similar proportions of survivors (71%) and controls (73%) reported consulting a general practitioner in the past year. Survivors were more likely than controls to consult with any specialist (68% vs. 46%), including an oncologist (29% vs. 0.3%). Survivors' consultations with oncologists increased with concurrent physical health problems (adjusted odds ratio [ORadj], 1.7, 95% confidence interval [CI], 1.4-2.1), history of high risk therapy (ORadj, 2.4, 95% CI, 1.9-2.9), and multiple treatment series (ORadj, 2.2, 95% CI, 1.7- 3.0), but decreased with time since diagnosis (ORadj, 0.3, 95% CI, 0.2-0.4).

CONCLUSION

Although most survivors reported consulting with at least 1 healthcare practitioner in the past year, the large majority did not report consulting an oncologist and thus may not be receiving optimal follow-up care. Moreover, consultations decreased with time since diagnosis, exactly when risk of late effects increases. This limited preventive care could have major implications on survivors' long-term health. Cancer 2006. © 2006 American Cancer Society.

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