BACKGROUND: Survivors of childhood cancer treated with central nervous system (CNS)-directed therapy may be at risk for poor health care utilization because of neurocognitive deficits. This study examined associations between neurocognitive function and adherence to routine and risk-based medical evaluations in adult survivors exposed to CNS-directed therapy. METHODS: Neurocognitive function and health care utilization were assessed in 1304 adult survivors of childhood cancer enrolled in the St. Jude Lifetime Cohort Study. Adherence to recommended care was defined as meeting guidelines published by the Children's Oncology Group. Multivariate models were used to evaluate associations between neurocognitive function and health screenings. Established predictors of health care utilization were included as covariates. Odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for variables maintained in the final models. RESULTS: Adherence to recommended medical care was higher for routine care (general physician care, 57.6%; dental care, 49.1%) versus specialized care (survivor-focused care, 21.9%; echocardiogram, 19.9%). Higher intelligence was predictive of general physician care (OR, 1.74; 95% CI, 1.41-2.15) and survivor-focused care (OR, 1.44; 95% CI, 1.13-1.83) in comparison with no care, whereas better executive function skills were associated with reduced dental care (PR, 0.94; 95% CI, 0.91-0.98). Echocardiogram monitoring was not associated with neurocognition. Possible late effects of cancer treatment (pain and reduced cardiorespiratory fitness) were associated with an increased likelihood of receiving specialized medical care. CONCLUSIONS: Survivors with reduced global cognition are at risk for poor health care utilization. Educational practices regarding recommended health care should be personalized to ensure comprehension by survivors with neurocognitive impairment.
BACKGROUND: Survivors of childhood cancer treated with central nervous system (CNS)-directed therapy may be at risk for poor health care utilization because of neurocognitive deficits. This study examined associations between neurocognitive function and adherence to routine and risk-based medical evaluations in adult survivors exposed to CNS-directed therapy. METHODS: Neurocognitive function and health care utilization were assessed in 1304 adult survivors of childhood cancer enrolled in the St. Jude Lifetime Cohort Study. Adherence to recommended care was defined as meeting guidelines published by the Children's Oncology Group. Multivariate models were used to evaluate associations between neurocognitive function and health screenings. Established predictors of health care utilization were included as covariates. Odds ratios (ORs) or prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated for variables maintained in the final models. RESULTS: Adherence to recommended medical care was higher for routine care (general physician care, 57.6%; dental care, 49.1%) versus specialized care (survivor-focused care, 21.9%; echocardiogram, 19.9%). Higher intelligence was predictive of general physician care (OR, 1.74; 95% CI, 1.41-2.15) and survivor-focused care (OR, 1.44; 95% CI, 1.13-1.83) in comparison with no care, whereas better executive function skills were associated with reduced dental care (PR, 0.94; 95% CI, 0.91-0.98). Echocardiogram monitoring was not associated with neurocognition. Possible late effects of cancer treatment (pain and reduced cardiorespiratory fitness) were associated with an increased likelihood of receiving specialized medical care. CONCLUSIONS: Survivors with reduced global cognition are at risk for poor health care utilization. Educational practices regarding recommended health care should be personalized to ensure comprehension by survivors with neurocognitive impairment.
Authors: Charles H Hinkin; David J Hardy; Karen I Mason; Steven A Castellon; Ramani S Durvasula; Mona N Lam; Marta Stefaniak Journal: AIDS Date: 2004-01-01 Impact factor: 4.177
Authors: Kevin R Krull; Tara M Brinkman; Chenghong Li; Gregory T Armstrong; Kirsten K Ness; Deo Kumar Srivastava; James G Gurney; Cara Kimberg; Matthew J Krasin; Ching-Hon Pui; Leslie L Robison; Melissa M Hudson Journal: J Clin Oncol Date: 2013-11-04 Impact factor: 44.544
Authors: Jeanne R Steele; Melanie Wall; Nicholas Salkowski; Pauline Mitby; Toana Kawashima; Mark W Yeazel; Melissa M Hudson; Leslie L Robison; Ann C Mertens Journal: J Cancer Surviv Date: 2013-04-09 Impact factor: 4.442
Authors: Michael L Alosco; Mary Beth Spitznagel; Manfred van Dulmen; Naftali Raz; Ronald Cohen; Lawrence H Sweet; Lisa H Colbert; Richard Josephson; Joel Hughes; Jim Rosneck; John Gunstad Journal: Psychosom Med Date: 2012-10-31 Impact factor: 4.312
Authors: Melissa M Hudson; Kirsten K Ness; James G Gurney; Daniel A Mulrooney; Wassim Chemaitilly; Kevin R Krull; Daniel M Green; Gregory T Armstrong; Kerri A Nottage; Kendra E Jones; Charles A Sklar; Deo Kumar Srivastava; Leslie L Robison Journal: JAMA Date: 2013-06-12 Impact factor: 56.272
Authors: Fiona S M Schulte; Michaela Patton; Nicole M Alberts; Alicia Kunin-Batson; Barbara A Olson-Bullis; Caitlin Forbes; K Brooke Russell; Alexandra Neville; Lauren C Heathcote; Cynthia W Karlson; Nicole M Racine; Courtney Charnock; Matthew C Hocking; Pia Banerjee; Perri R Tutelman; Melanie Noel; Kevin R Krull Journal: Cancer Date: 2020-10-28 Impact factor: 6.860