Reducing racial/ethnic inequities in childhood cancer survivorship

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DESCRIPTION (provided by applicant): Despite improved survival, childhood cancer survivors (CCS) are at high risk of late and long term effects from their disease and rigorous treatment. Hispanic CCS, who are underrepresented in survivorship research, show significant health inequities in mortality compared to non-Hispanics. Although life-long, risk based follow-up care is recommended for CCS, use of this care drops rapidly as CCS enter emerging adulthood. Our preliminary work among CCS treated at two hospitals (ages 14-26 when surveyed) indicates that cancer related follow-up care is significantly lower among Hispanic (vs. non-Hispanic) CCS during the early years of emerging adulthood (ages 21-26). We propose to recruit and survey a population-based cohort (n=1,232) of emerging adult (ages 18-39) Hispanic (54%) and non-Hispanic CCS to understand potential inequities in the receipt of recommended follow-up care, as well as factors that may differentially affect health outcomes of Hispanic and non-Hispanic CCS. Our aims are to determine: 1) risk and protective factors of receiving cancer related follow-up care; 2) if the follow-up care received (based on medical records review) is consistent/adherent with published Long- Term Follow-up Guidelines (for patient specific cancer and clinical history); and, 3) the relationship between milestones of emerging adulthood (e.g., full-time employment, marriage, having children) and receipt of cancer related follow-up care. Adherence to guideline care will be assessed by a physician panel. Comparative analyses will be used to identify differences by ethnicity and treatment site (cancer survivorship clinics and at primary care/community clinics). Results from this population-based study will provide guidance to identify and reduce health inequities observed between Hispanic and non-Hispanic CCS in health care utilization, late effects, and ultimately, long term survival. Results can guide education/policy efforts focused on clinicians who treat Hispanic CCS as well as support specialized transition clinics and health promotion efforts focused on CCS entering emerging adulthood.