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Use of health care services by survivors of childhood and adolescent cancer in Canada
Article first published online: 15 MAR 2006
Copyright © 2006 American Cancer Society
Volume 106, Issue 8, pages 1829–1837, 15 April 2006
How to Cite
Shaw, A. K., Pogany, L., Speechley, K. N., Maunsell, E., Barrera, M. and Mery, L. S. (2006), Use of health care services by survivors of childhood and adolescent cancer in Canada. Cancer, 106: 1829–1837. doi: 10.1002/cncr.21798
- Issue published online: 4 APR 2006
- Article first published online: 15 MAR 2006
- Manuscript Accepted: 4 NOV 2005
- Manuscript Revised: 3 NOV 2005
- Manuscript Received: 19 JUL 2005
- Health Canada
- childhood cancer;
- follow-up care;
- health service use
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.
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.
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).
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.