Long-term surveillance and preventive practices among healthy young adult cancer survivors.

Abstract

6121 Background: Due to advances in cancer therapy, many young adult cancer survivors (YACS) will be cured. As time lapses from active treatment, it is unknown whether YACS remain engaged in the health care system by participating in recommended preventive and screening practices. Methods: This is a population-based study using cancer registry and administrative data. We identified all adults aged 20 - 44 diagnosed with a malignant tumor between 1992 and 1999 in the Ontario Cancer Registry. We excluded individuals who died or showed evidence of recurrence within 5 years of diagnosis. Patients were matched 1:5 according to age, sex and geography to randomly selected controls who were cancer free prior to observation. Using administrative data, we identified preventive maneuvers including screening for hypercholesterolemia, cervical, breast and colorectal cancer (CRC), influenza shots and general health examinations occurring more than 5 years after diagnosis in survivors and controls. Relative health service use between survivors and controls was estimated using Poisson regression models, adjusting for income and time from diagnosis. Survivors were censored if there was evidence of recurrence. Results: 20,320 YACS and 101,571 controls were identified. Women with a history of breast cancer had more annual mammograms compared to their controls: aged 40-49 (relative rate ratio [RR] 3.46, 95% confidence interval [CI] 3.34-3.60, P<0.001); and aged 50-59 (RR 2.03, 95% CI 1.93-2.13, P<0.001). The table provides RR and CI of preventive practices, survivors compared to controls. Conclusions: Compared to controls, YACS are more likely to participate in many healthy preventive and screening practices more than 5 years after diagnosis. Preventive practice Rate ratio 95% CI P value Cervical cancer screening Screening mammogram Age 40-49 Age 50-59 CRC screening FOBT Endoscopy Flu vaccination General health exam Cholesterol screening Females 50-59 Males 40-49 Males 50-59 1.06 1.25 1.07 0.95 1.29 2.37 1.09 1.01 1.04 1.01 1.05, 1.07 1.21, 1.29 1.03, 1.11 0.90, 1.01 1.24, 1.35 2.10, 2.68 1.07, 1.10 0.99, 1.03 1.02, 1.07 0.97, 1.05 <0.0001 <0.0001 0.0002 0.08 <0.0001 <0.0001 <0.0001 0.38 0.0008 0.65