ASPO Abstracts
Access to care and social support in the mid-pandemic: a population-based study of adolescents and young adults with cancer
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose of the study: Adolescents and young adults with a history of cancer (AYAs) experienced disproportionate disruptions in health care and reported declines in social and emotional support in the early pandemic, before the development of vaccines. We aimed to examine the impact of COVID-19 on access to health care and social and emotional support in a nationally representative sample of AYAs during the mid-pandemic, when vaccines were available. Methods: We identified 148 AYAs (age 18-39 years) with a history of cancer and 592 age- and sex-matched non-cancer controls from the 2021 population- based National Health Interview Survey (NHIS). We estimated the proportion of AYAs and non-cancer controls reporting disruptions in health care due to the pandemic (delayed getting care, did not get needed care), virtual healthcare visits in the past year, and less social and emotional support than a year ago. Results: AYAs identified as Asian (1.3%), Hispanic (12.9%), non-Hispanic Black (8.3%), and non-Hispanic White (72.3%). Median age at diagnosis was 25 years (IQR 19-31 years). The most common cancer types were gynecologic (27.3%), melanoma or other skin cancers (22.6%), and lymphomas or leukemias (14.5%). A similar proportion of AYAs and non-cancer controls had ever had COVID-19 (15.3% vs. 15.1%, p=0.95). Nearly one in four AYAs delayed care (23.3% vs. 18.0%, p=0.18), and one in six did not get needed care (14.9% vs. 12.8%, p=0.48) due to the pandemic; however, these disruptions were similar among non-cancer controls. Nearly half of AYAs reported a virtual health care visit in the past year compared to one-third of non-cancer controls (44.9% vs. 34.8%, p<0.05). More AYAs than non-cancer controls reported receiving less social and emotional support than a year ago (18.7% vs. 9.4%, p<0.02). Conclusions: Many AYAs–who are at risk for cancer recurrence, progression, and long-term and late effects–delayed or went without needed care because of the pandemic, even in 2021. Unlike their peers without cancer, AYAs continued to experience declining social and emotional support in the mid-pandemic. Interventions to increase social support are critically needed to mitigate the challenges of simultaneously coping with cancer and the pandemic as an adolescent or young adult.
Keywords: adolescent and young adult cancer, COVID-19, cancer survivorship