Healthcare Utilization in a Childhood and Adolescent Cancer Survivor Cohort Open Access

Boyer, Lillian (Spring 2020)

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Background: Due to late effects from receiving treatment for childhood cancer, childhood cancer survivors are at an increased risk for chronic conditions and mortality. Better preventative care can be provided by learning about their healthcare utilization through evaluating hospitalization, emergency room visits, doctors’ visits and surgery among the childhood and adolescent cancer survivor cohort.

Methods: Baseline surveys from the Children’s Healthcare of Atlanta Childhood, Adolescent, and Young Adult Cancer Survivor Study (CHOA-CAYACSS) completed by patient or parent proxy were merged with treatment history extracted from medical records. Eligible survivors were ≤ 22 years at the time of baseline survey and were ≥ 2 years off therapy. We used univariate analyses to identify factors to be included in the hospitalization, emergency room visits, doctors’ visits and surgery multivariate analyses. Reasons for each of the outcomes were classified using ICD-9 codes.

Results: The sample included 867 survivors (51% male, 84% completed by parent proxy, and 68% white). 5% of the cohort was hospitalized, 20% of the cohort was seen in the emergency room, 52 % visited a doctor and 10% had surgery in the year before visiting the cancer survivor clinic. Self-reported rating of general health was predictive in all of the models. All multivariate models included sex and age at diagnosis. Using ICD-9 codes, injury (32%) followed by symptoms (20%) were listed as the reason for emergency room visit, external (17%) and infectious (13%) were the highest among doctors’ visits, health services (17%), gastrointestinal (13%) and injury (12%) among surgery and health services (20%) and symptoms (17%) among hospital visits.

Conclusion: Further research is needed to understand the healthcare utilization of childhood cancer survivors to investigate factors leading to these outcomes and provide preventative care.

Table of Contents

I. Introduction 1

Childhood and Adolescent Cancer 1

Incidence 1

Survival Rates 3

Childhood Cancer Survivorship 3

II. Materials and Methods 7

Data Analysis 10

III. Results 12

Study Population 12

Demographic Characteristics 12

Clinical Characteristics and Treatment History 12

Characteristics of the Survivors Hospitalized 13

Characteristics of the Survivors Visiting the Emergency Room 15

Characteristics of the Survivors Visiting the Doctor 16

Characteristics of the Survivors Undergoing Surgery 17

ICD-9 codes for Hospitalization, Emergency Room, Doctor Visits and Surgery 18

Hospitalization 19

Emergency room visits 19

Doctor visits 20

Surgery 21

IV. Discussion 23

V. Summary, Public Health Implications, and Future Directions 27

VI. References 29

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