Follow-up care and preventive service use among survivors of adolescent and young adult cancer.

项目总结/摘要 大约有70，000名年龄在15至39岁之间的青少年和年轻人（AYAs）被诊断为 美国每年都有癌症患者。随着癌症发病率在AYAs继续上升和5年 大多数AYA癌症的存活率超过80%，AYA癌症的幸存者人数迅速增加， 扩张AYA癌症的幸存者，像所有其他癌症幸存者一样，面临着有害的晚期影响的风险， 癌症及其治疗，包括第二次癌症，器官衰竭以及其他严重疾病。 此外，随着AYA癌症幸存者年龄的增长，他们因慢性合并症而发病和死亡的风险 增加因此，谨慎的是，卫生服务，以防止这些慢性疾病的发病和发展， 合并症是他们综合生存护理计划的一部分。然而，很少有人知道如何照顾， 提供癌症后诊断，特别是对AYA癌症的幸存者。鉴于需要基于证据的 研究，以告知和改善AYA癌症幸存者的生存护理，这一总体目标 这项研究是为了提高我们对AYA癌症幸存者的后续护理的理解，并确定 来提高它的质量。我们的具体目标是（1）检查儿童肿瘤组的依从性 (COG)AYA癌症幸存者的长期随访指南（LTFG）;（2）检查对 AYA癌症幸存者的人群预防性护理指南;（3）评估依从性的变化 按个人分列的AYA癌症幸存者中的COG LTFG和人口预防保健指南， 供应商和系统级因素。我们将利用凯撒南方医疗机构的丰富资源 加州（KPSC）是一个大型综合医疗保健服务系统，覆盖了超过1%的美国人口。 关于癌症治疗暴露、卫生服务利用以及患者、提供者的详细信息 5,986名AYA癌症幸存者的系统级特征可通过KPSC的电子 为实现所提出的具体目标而建立的健康记录。此应用程序利用了 KPSC和亚拉巴马大学的研究人员，在癌症生存，健康和癌症治疗方面拥有多学科的专业知识， 服务研究、流行病学、生物统计学和医学肿瘤学。实现这些目标将：（1）有助于 确定AYA癌症幸存者是否接受适当的随访和预防服务;（2）确定实践 可以改善的差距，以提供全面的癌症生存护理;（3）提供证据， 提高癌症生存护理质量的整体政策。该提案的结果也将作为 为未来的研究应用奠定基础，以开发和测试有针对性的多层次干预措施， AYA癌症幸存者的护理质量和协调。

Project Summary/Abstract Approximately 70,000 adolescents and young adults (AYAs) between the ages of 15 and 39 are diagnosed with cancer each year in the United States. As cancer incidence in AYAs continues to rise and the 5-year survival among most AYA cancers exceeds 80%, the population of survivors of AYA cancer is rapidly expanding. Survivors of AYA cancers, like all other cancer survivors, face risk of detrimental late effects of cancer and its treatment, including second cancers, organ failure, as well as other serious illnesses. Furthermore, as survivors of AYA cancer age, their risk of morbidity and mortality due to chronic comorbidities increase. It is thus prudent that health services to prevent the onset and progression of these chronic comorbidities be part of their integrated survivorship care plan. However, little is known regarding how care is delivered post-cancer diagnosis, particularly for survivors of AYA cancer. Given the need for evidence-based research to inform and improve survivorship care for survivors of AYA cancer, the overarching goal of this study is to advance our understanding on follow-up care for survivors of AYA cancer and identify areas to improve its quality. Our Specific Aims are (1) to examine the adherence to Children’s Oncology Group (COG) Long-Term Follow-up Guidelines (LTFG) by survivors of AYA cancer; (2) to examine the adherence to population preventive care guidelines by survivors of AYA cancer; and (3) to evaluate variations in adherence to COG LTFG and population preventive care guidelines among survivors of AYA cancer by individual-, provider-, and system-level factors. We will employ the rich resources of the Kaiser Permanente Southern California (KPSC), a large integrated healthcare delivery system that covers >1% of the US population. Detailed information regarding cancer therapeutic exposures, health service utilization, and patient-, provider- and system-level characteristics for 5,986 survivors of AYA cancer is available through KPSC’s electronic health records for accomplishing the proposed specific aims. This application leverages collaboration between investigators at KPSC and University of Alabama, with multidisciplinary expertise in cancer survivorship, health service research, epidemiology, biostatistics, and medical oncology. Completion of these aims will: (1) help to determine if survivors of AYA cancer receive appropriate follow-up and preventive services; (2) identify practice gaps that can be improved to deliver comprehensive cancer survivorship care; (3) provide evidence to inform policies to improve the quality of cancer survivorship care overall. Findings from this proposal will also serve as a basis for future research application to develop and test targeted multi-level interventions to directly improve the quality and coordination of care for survivors of AYA cancer.