Introduction This analysis examined the influence of ethnicity on health care access received and planned for the future and the effect of ethnicity on health concerns in adult minority childhood cancer survivors.
Methods Cross-sectional data from 77 black, 118 Hispanic, 40 Asian, and 718 non-Hispanic white (NHW) adult childhood cancer survivors. Four self-reported measures defined health care access: general contact with the health care system in the past 2 years, cancer related follow-up (CRFU) care in the past 2 years, planning a CRFU in next 2 years, and ever had a CRFU. Health locus of control variables: concern about future health, worry about cancer recurrence, and perceived parental or spousal concern about survivor's health. Odds ratios (OR) and 95% confidence intervals (CI) were estimated (NHW = referent).
Results Mean age of survivors at time of interview = 31 years (range 18-51). Asians (18%) were less likely to report ever having had a CRFU (p < .05) vs NHW (35%). Blacks were more likely to report being worried about the cancer recurrence (20.8%) compared to NHW (12.6%, p = .0461). Adjusting for education, insurance status, and age at interview, black females had higher odds of CRFU in the last 2 years (OR = 2.4; CI = 1.2-4.5). Hispanics were more likely to report being worried about the cancer recurrence (19.5%) vs NHW (12.6%, p = .0438), more likely to report concern about future health (39%) vs NHW (21.2%, p < .0001), more likely to report their parents being worried about their health (72.7%) vs NHW (54.5%, p = .0002); and more likely to report their spouse being worried about their health (52.6%) vs NHW (34.1%, p = .0067). Adjusting for education, insurance status, and age, male Hispanics were more likely to be planning a CRFU (OR = 2.3; CI 1.2-4.3). Adjusting for education, insurance status, age, and gender Hispanics were more likely to be concerned about future health (OR = 2.2; CI = 1.4-3.4), more worried about cancer coming back (OR = 1.7; CI = 1.0-3.0), more likely to report parents (OR = 2.1; CI = 1.4-3.4), and spouses (OR = 2.5; CI = 1.4-4.5) being worried about their health.
Conclusions Different etiologies including internal factors, such as concern for recurrence of malignancy, as well as external factors, such as parental or spousal concern about the survivor's health, may explain the varied patterns in access to cancer-related follow-up care in minority survivors of childhood cancer.
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