Young Cancer Survivors Forgoing Follow-Up Care

Adolescent and young adult cancer survivors have a higher rate of heart disease, infertility, and cancer recurrence.

For any condition or health problem, receiving proper follow-up care is crucial to prevent adverse events and additional crises.

A study recently presented at the American Society of Clinical Oncology 2018 Survivorship Symposium suggests that a large portion of adolescent and young adult (AYA) cancer survivors do not seek follow-up health care services after treatment ends.

This patient population is at an increased risk of cardiovascular problems, infertility, and secondary cancers, according to the study. Skipping follow-up care could leave the AYA survivor population at risk of serious complications.

The authors of the study found that nearly half of AYA patients diagnosed with cancer between 2005 and 2009 did not seek a follow-up visit with an oncologist in 2016. One-third of those diagnosed between 2010 and 2014 did not seek an oncologist appointment in 2016, according to the study.

“Many adolescents and young adults are unaware of what their long-term risks are after they have finished their cancer treatment,” said lead study author Lynda M. Beaupin, MD. “Doctors and other health care providers need to be more diligent in letting these patients know about future potential side-effects and health risks that could occur based on certain aspects of their cancer treatment.”

Previously, the authors held a group discussion with 27 AYAs (aged 18 to 39 years) to focus on barriers that prevent access to follow-up care. Key factors included poor communication with their oncologist, problems adjusting to life as a survivor, and loss of insurance, according to the study.

To further investigate this issue, the authors analyzed data—including current age, age at diagnosis, gender, date of diagnosis, date of most recent physician visit, and cancer type—for patients treated at Roswell Park Comprehensive Cancer Center.

The most common cancers were leukemia/lymphoma, melanoma, germ cell tumors, thyroid cancer, and breast cancer.

Patients with the 5 aforementioned cancers were placed in cohorts based on when they were diagnosed: 852 patients diagnosed between 2010 and 2014 and 783 patients diagnosed between 2005 and 2009.

The authors discovered that the length of time since last cancer treatment was the most significant factor in not following-up. Approximately 48% of patients in the 2005 to 2009 cohort and 33% of patients in the 2010 to 2014 cohort did not have an appointment with their oncologist in 2016, according to the study.

The authors reported that cancer type was not found to play a role in follow-up.

Health insurance status was not a factor in whether patients in the 2005 to 2009 cohort sought a follow-up; however, slightly more uninsured patients did not schedule a follow-up visit compared with insured patients in the other cohort, according to the study.

“These patients have the potential to live a normal lifespan, and we need to educate them to become their own advocates, so they may receive follow-up care on a regular basis,” Dr Beaupin said. “We hope they continue to receive that follow-up at an established cancer center that has the facilities to assess cardiac health and provide rehabilitation if needed.”

In future studies, the authors hope to investigate whether other factors may affect the likelihood of AYAs scheduling follow-up care, including employment, distance to cancer centers, treatment location, and how they perceive their quality of life.

“Thanks to decades of advances in cancer treatment for young people, adolescents and young adults who survive cancer today can have a full life ahead of them. But maintaining their health over the course of many years requires attentive follow-up care,” said session moderator Timothy Gilligan, MD, MSc, FASCO. “This study shows we have work to do to ensure more young adult cancer survivors receive the follow-up care they need.”