Abstract
Cancer survivors are more likely to report having a poor health status when compared to the general population. Few studies have focused on the impact of cancer on health status and healthcare utilization/access outcomes among women from medically underserved populations. 25,741 women with and without a history of cancer from the National Health and Nutrition Examination Survey from 1999 to 2016 contributed data. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression for associations between cancer status and perceived health and healthcare utilization/access outcomes stratified by race/ethnicity, poverty status, education, and comorbidities. 1,897 (7.0%) women had a history of cancer with breast cancer as the most common (n = 671, 35.7%). While most survivors were non-Hispanic white (69.4%), 13.9% were Hispanic, 12.0% were non-Hispanic Black, and 4.6% were additional racial/ethnic groups. Survivors were 1.32 times more likely to be hospitalized within the last year (95% CI 1.11-1.58) and 1.32 times more likely to see a mental health provider within the last year (95% CI 1.05-1.66) compared to cancer-free women. Race/ethnicity was a significant effect modifier in the association between being a survivor and seeing a mental health provider, with Hispanic survivors having the highest odds (aOR 3.44; 95% CI 2.06-5.74; p-interaction < 0.00). Our study identifies disparities in healthcare utilization among female cancer survivors, highlighting the importance of evaluating these associations among medically underserved populations. These findings can educate healthcare professionals working with these populations to inform gaps in survivorship care utilization/access.
Highlights
In 2020 there were an estimated 16.9 million cancer survivors living in the United States (US), with more than 67% surviving more than five years post-diagnosis[1]
Survivors were 1.28 times more likely to report fair/poor perceived health status, 1.61 times more likely to report hospitalizations in the last year, and 1.37 times more likely to see a mental health provider within the last year compared to controls
The current study aims to determine the association between being a cancer survivor vs cancer-free individual and a number of health-related outcomes, adjusting for covariates
Summary
In 2020 there were an estimated 16.9 million cancer survivors living in the United States (US), with more than 67% surviving more than five years post-diagnosis[1]. Surviving cancer does not guarantee higher quality of life (QOL) or overall betterment of health, as there are many complications from cancer treatment, recurrence, and related comorbid conditions that occur throughout survivorship[3,4,5]. Female cancer survivors face barriers to successful and long-term health, including several physical and psychosocial aspects (e.g., related comorbid conditions, recurrence, mental health outcomes, etc.) that span the entire cancer continuum, a framework that describes the understanding and experience from cancer etiology to survivorship[6]. There are groups, such as disadvantaged health populations (e.g., racial/ethnic minorities, those of lower socioeconomic position [SEP], those with lower educational attainment, those with chronic conditions, etc.) that under-utilize routine healthcare during cancer survivorship[12, 13]. Few studies have focused on the impact and resonance of cancer on perceived health as well as healthcare utilization and access among women from disadvantaged health populations on a national level[26]
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