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Health Care Utilization among Adult Survivors of Childhood and Adolescent Cancer in Ontario

Abstract

Survivors of childhood and adolescent cancers are at increased risk for late effects including subsequent cancer, cardiotoxicities, and poor psychosocial health. Few studies have investigated if this translates into increased health care use and costs during survivorship. This thesis aimed to address key knowledge gaps in the field of survivorship and health care service utilization using population-based data in Ontario, Canada. First, we compared rates of health care use between survivors and matched controls across a diverse array of outcomes including hospitalizations, emergency department visits, primary care visits, and diagnostic investigations. We demonstrated higher rates of health care use across all outcomes among survivors compared to cancer-free controls. Our second study leveraged the matched-cohort and evaluated long-term health care costs from the perspective of the public payer. We found that survivors consistently incurred higher health care costs throughout long-term follow-up and in their final year of life, with hospitalizations as the most significant cost driver. Lastly, we focused on childhood and adolescent cancer survivors and compared acute health care utilization across varying models of long-term follow-up. In Ontario, there are three models of long-term follow-up care: specialized survivor clinics (AfterCare), care from an oncologist at a general cancer clinic, and care from a primary care physician. Within our survivor cohort, we observed sub-optimal adherence to any ii model of long-term follow-up care. We demonstrated that survivors with recent attendance at AfterCare Clinics was associated with a decrease in emergency department visits compared to survivors with no regular survivorship care. We did not observe any effect between AfterCare visits and rates of hospitalizations. Ultimately, to reduce morbidity, premature mortality, and subsequent acute health care use, greater adherence to long-term follow-up and surveillance strategies are needed. Our findings provide insight on health care use among this population for consideration by policymakers and will be useful to inform allocation of resources for this growing population of young Canadians.