ASPO Abstracts
Healthcare access barriers by race/ethnicity and self-reported health among adolescent and young adult cancer survivors
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023
Abstract Body:
Purpose of the study: Adolescent and young adult (AYA) cancer survivors are at risk of treatment-related late effects but face barriers in accessing follow-up care. Methods: AYA survivors (aged 15-39 years at diagnosis) were identified from the UNC Cancer Survivorship Cohort; eligible participants were aged ≥18 years at enrollment and had an appointment at a UNC oncology clinic during 2010-2016. The analytic sample was restricted to survivors who were ≥1 year post-diagnosis. We examined the prevalence of self-reported dimensions of healthcare access (HCA), overall and by race/ethnicity: affordability (ability to pay); accessibility (location of services); availability (quality, volume of services); accommodation (organization of services); and acceptability (attitudes toward providers). We used modified Poisson regression to estimate prevalence ratios (PRs) and 95% CIs for the association between HCA dimensions and self-reported health, adjusted for age at diagnosis, time since diagnosis, sex, and race/ethnicity. Results: The sample included 135 AYA survivors who were a median age of 34 (IQR: 29-37) years at diagnosis and 4 (IQR: 2-10) years from diagnosis. The most common cancer type was breast (41%). The sample included 74% non-Hispanic (NH) white, 16% NH Black, and 7% Hispanic survivors. A majority (70%) of survivors, and particularly NH Black survivors (90%), reported delaying/forgoing care in the past year because of ≥1 HCA barrier, including acceptability (50%), affordability (31%), availability (22%), accommodation (20%), or accessibility (6%). Compared to NH white survivors, NH Black survivors more frequently reported barriers of acceptability (75% vs. 46%). Nearly one in three survivors (29%) reported fair or poor health. Affordability barriers were associated with an increased likelihood of self-reported fair/poor health (PR: 1.92, 95% CI: 1.12-3.28). Health status was not associated with other HCA dimensions. Conclusions: Among AYA survivors who were accessing care at a comprehensive cancer center, HCA barriers were related to a high prevalence of delaying or forgoing care, particularly among NH Black survivors, and can contribute to worse health. Findings highlight the need to target specific barriers to care for AYA survivors to improve health.
Keywords: Adolescents and Young Adults; Survivorship; Healthcare Access; Health Disparities