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

项目摘要/摘要 约有70,000名15岁至39岁的青少年和青壮年(AYA)被诊断出 在美国，每年都有癌症患者。随着AYA的癌症发病率持续上升，5年来 大多数Aya癌症的存活率超过80%，Aya癌症的幸存者人数正在迅速增加 正在扩张。Aya癌症的幸存者，像所有其他癌症幸存者一样，面临着有害的晚期效应的风险 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，由于Aya癌症幸存者的年龄，他们因慢性合并症而致病和死亡的风险 增加。因此，预防这些慢性疾病发生和发展的卫生服务是谨慎的 合并症是他们综合生存护理计划的一部分。然而，关于护理是如何进行的，我们知之甚少。 提供癌症后诊断，特别是为Aya癌症幸存者提供诊断。鉴于以证据为基础的需求 研究告知和改善Aya癌症幸存者的生存护理，这是这个项目的首要目标 这项研究是为了增进我们对Aya癌症幸存者后续护理的理解，并确定领域 以提高其质量。我们的具体目标是(1)检查儿童肿瘤学小组的遵守情况 (COG)Aya癌症幸存者长期随访指南(LTFG)；(2)检查遵守 Aya癌症幸存者的人口预防护理指南；以及(3)评估依从性的变化 对癌症幸存者按个人进行COG、LTFG和人群预防护理指南-， 提供商和系统级别的因素。我们将利用南方帝王的丰富资源 加州(KPSC)，一家覆盖美国1%人口的大型综合医疗保健提供系统。 关于癌症治疗暴露、卫生服务利用以及患者和提供者的详细信息- 5986名Aya癌症幸存者的系统级特征可通过KPSC的电子 实现所提议的具体目标的健康记录。此应用程序利用 KPSC和阿拉巴马大学的研究人员，在癌症生存、健康方面拥有多学科专业知识 服务研究、流行病学、生物统计学和医学肿瘤学。完成这些目标将：(1)有助于 确定Aya癌症幸存者是否得到适当的后续和预防服务；(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)提供证据以告知 全面提高癌症生存护理质量的政策。这项提案的结果还将作为 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，以直接改善 Aya癌症幸存者护理的质量和协调。

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.