Healthcare Utilization in a Childhood and Adolescent Cancer Survivor Cohort Open Access
Boyer, Lillian (Spring 2020)
Abstract
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
About this Master's Thesis
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