Socioeconomic Factors and Adherence to Healthcare Recommendations in Adolescent and Young Adult Cancer Survivors

Introduction: The majority of adolescent and young adult (AYA) cancer survivors do not receive recommended healthcare surveillance after completing cancer therapy. The impact of socioeconomic status and social support factors such as income, education, marital status, and insurance on healthcare adherence among AYA cancer survivors is unknown.

Methods: Five cancer centers invited eligible survivors diagnosed between ages 18-39 years who were 1-5 years from cancer therapy completion. Participants completed online surveys including sociodemographic factors, patient-reported outcomes, and the Healthcare Adherence (HCA) measure to assess healthcare services and screening test utilization. Diagnosis and treatment data were abstracted from medical records. Using the standard adherence cutpoint based on AYA survivorship guidelines, nonadherence was defined as a score <0.80 (range 0- 1.0). We used multivariable logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CI) for adherence in relation to socioeconomic status and social support factors.

Results: Of 344 participants, 36% were adherent to healthcare recommendations. Nonadherence was associated with having less education (OR 0.43; 95% CI: 0.23-0.80 for < 4- year college degree), and relatively low household income (OR 0.51; 95% CI: 0.28-0.95 for $41,000-$80,000; OR 0.40; 95% CI: 0.19-0.86 for ≤ $40,000). Decreased adherence was 4 observed in those not identifying as Non-Hispanic White among breast cancer survivors (OR 0.39, 95% CI: 0.16-0.99). Nonadherence was increasingly associated with lower income levels among survivors <3 years after diagnosis (OR 0.25; 95% CI: 0.07-0.93 for $81,000-$120,000; OR 0.24; 95% CI: 0.07-0.84 for $41,000-$80,000; OR 0.13; 95% CI: 0.03-0.60 for ≤ $40,000).

Conclusion: Nonadherence to healthcare guidelines was associated with lower income and education levels in general, and with reported Non-White status among AYA breast cancer survivors. Identification of barriers to adherence in AYA cancer survivors will help in the design of interventions to meet the needs of these high-risk groups, particularly during the first years after diagnosis.