Barriers and facilitators of risk‐based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Background Optimal risk‐based survivor health care includes surveillance for late effects and education targeted at reducing or preventing risky health behaviors. Understanding the reasons for a lack of risk‐based follow‐up care is essential. Methods Adult participants from the Childhood Cancer Survivor Study were surveyed about having a cancer‐related visit in the past 2 years and the likelihood of having a cancer‐related visit in the future. Additional factors thought to be related to the primary outcomes were also assessed. Results Nine hundred seventy‐five survivors completed the survey. Twenty‐seven percent (95% confidence interval [CI], 24%‐30%) had a cancer‐related medical visit in the previous 2 years, and 41% (95% CI, 38%‐44%) planned to have such a visit within the next 2 years. The likelihood of having had a cancer‐related visit within the last 2 years was higher among survivors assigning greater importance to these visits (relative risk [RR], 1.2; 95% CI, 1.1‐1.3), perceiving greater susceptibility to health problems (RR, 1.2; 95% CI, 1.1‐1.3), having a moderate to life‐threatening chronic health problem related to their cancer (RR, 2.1; 95% CI, 1.7‐2.7), seeing a primary care provider for a cancer‐related problem (RR, 1.3; 95% CI, 1.0‐1.6), having a cancer treatment summary (RR, 1.3; 95% CI, 1.0‐1.6), and endorsing greater confidence in physicians' abilities to address questions and concerns (RR, 1.2; 95% CI, 1.0‐1.3). Conclusions Educational interventions improving awareness of treatment history and susceptibility to cancer‐related late effects and corresponding risk‐based care are likely to be beneficial for survivors of childhood cancers. Among 975 adult survivors of childhood cancer, nearly three‐quarters reported no cancer‐related health care visit in the preceding 2 years. Survivors with health problems, primary care providers, and higher perceived susceptibility to late effects are more likely to be receiving or planning cancer‐related care; factors such as transportation and a lack of health insurance are unrelated to cancer‐related care.