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.

Public Health Relevance

To examine, using a population-based cohort of childhood cancer survivors throughout Los Angeles County, risk and protective factors of cancer related follow-up care among recently treated emerging adult Hispanic and non-Hispanic childhood cancer survivors. Hispanics are substantially underrepresented in cancer survivorship research and results from this study will provide guidance to identify and reduce health disparities observed between Hispanic and non-Hispanic survivors in health care utilization, late effects and unmet needs.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZMD1)
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Alvidrez, Jennifer L
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University of Southern California
Public Health & Prev Medicine
Schools of Medicine
Los Angeles
United States
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Milam, Joel; Slaughter, Rhona; Tobin, Jessica L et al. (2018) Childhood Cancer Survivorship and Substance Use Behaviors: A Matched Case-Control Study Among Hispanic Adolescents and Young Adults. J Adolesc Health 63:115-117
Miller, Kimberly A; Ramirez, Cynthia N; Wojcik, Katherine Y et al. (2018) Prevalence and correlates of health information-seeking among Hispanic and non-Hispanic childhood cancer survivors. Support Care Cancer 26:1305-1313
Tobin, Jessica; Allem, Jon-Patrick; Slaughter, Rhona et al. (2018) Posttraumatic growth among childhood cancer survivors: Associations with ethnicity, acculturation, and religious service attendance. J Psychosoc Oncol 36:175-188
Tobin, Jessica; Miller, Kimberly A; Baezconde-Garbanati, Lourdes et al. (2018) Acculturation, Mental Health, and Quality of Life among Hispanic Childhood Cancer Survivors: A Latent Class Analysis. Ethn Dis 28:55-60
Miller, Kimberly A; Wojcik, Katherine Y; Ramirez, Cynthia N et al. (2017) Supporting long-term follow-up of young adult survivors of childhood cancer: Correlates of healthcare self-efficacy. Pediatr Blood Cancer 64:358-363
Milam, Joel; Slaughter, Rhona; Meeske, Kathleen et al. (2016) Substance use among adolescent and young adult cancer survivors. Psychooncology 25:1357-1362
Weiss, Aaron R; Hayes-Lattin, Brandon; Kutny, Matthew A et al. (2015) Inclusion of Adolescents and Young Adults in Cancer Clinical Trials. Semin Oncol Nurs 31:197-205