Many survivors of adolescent and young adult cancers avoid routine medical care because it's too expensive, despite the fact that most have health insurance. That is the conclusion of a new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The results indicate that expanding insurance coverage for young cancer survivors may be insufficient to safeguard their long-term health without efforts to reduce their medical cost burdens.

Medical care in the years after a cancer diagnosis is particularly important for detecting any long-term health conditions associated with their cancer treatment; however, little is known about the extent of care that survivors of adolescent and young adult cancers receive in the years after their diagnosis and treatment.

To investigate, Anne Kirchhoff, PhD, MPH, of Huntsman Cancer Institute at the University of Utah in Salt Lake City, and her colleagues analyzed national survey responses from younger adults ages 20-39 years: 979 who were diagnosed with cancer between the ages of 15 to 34 years and were at least five years from diagnosis, compared with 67,216 controls who had no cancer history.

While adolescent and young adult cancer survivors had similar rates of being uninsured as those without cancer (21 percent versus 23 percent), survivors were 67 percent more likely to forgo routine medical care due to costs in the previous year. Cost barriers were particularly high for younger survivors aged 20 to 29 years (44 percent versus 16 percent of controls) and female survivors (35 percent versus 18 percent of controls). Survivors reporting poorer health also experienced more cost barriers.

"The Affordable Care Act is an important step to ensuring that adolescent and young adult cancer survivors have health insurance coverage and improving their health care access; however, they need to be educated about the importance of regular health care to monitor for late effects," said Dr. Kirchhoff. "Furthermore, even the insured survivors in our study reported unmet health care needs due to cost barriers, suggesting that adolescent and young adult cancer survivors need resource supports beyond health insurance."

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