141st APHA Annual Meeting

In This section

Health perceptions, behavior, and medical care utilization: Links to mortality in adult survivors of childhood cancer

Monday, November 4, 2013

Cheryl L. Cox, RN, PhD , Epidemiology, Cancer Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
Vikki Nolan, DSc , School of Public Health, University of Memphis, Memphis, TN
Wendy Leisenring, ScD , Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, WA
Yutaka Yasui, PhD , Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
Susan Ogg, MSN , Epidemiology Cancer Prevention and Control, St.. Jude Children's Research Hospital, Memphis, TN
Joseph Neglia, MD , Department of Pediatrics, University of Minnesota, Minneapolis, MN
Kirsten Ness, PhD , Epidemiology, St. Jude Children's Research Hospital, Memphis, TN
Leslie L. Robison, PhD , Epidemiology, Cancer Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
Background: Adult survivors of childhood cancer have a substantially elevated mortality rate. We assessed whether health concerns, self-rated health status, health-related behaviors, and medical care utilization are associated with late mortality independently of primary disease and treatment.

Methods: Using the Childhood Cancer Survivor Study cohort, we compared the relation of risk factors of interest to mortality in 445 participants who died of causes other than injury, accident, or cancer and 7162 surviving participants individually matched for primary diagnosis, age at baseline questionnaire, time from diagnosis to baseline questionnaire, and length of time at risk. The odds ratio (OR) and 95% confidence interval (CI) were calculated by using multivariable conditional logistic regression models.

Results: After adjustment for education, income, treatment exposures, and number/severity of chronic illnesses, 5-6 (OR=2.07, CI: 1.40 - 3.06) through more than 20 (OR=3.87, CI: 2.55 - 5.87) physician visits during the past year, self-reported fair to poor health (OR=1.98, CI: 1.45 - 2.71), and underweight (OR=2.58, CI: 1.55 - 4.28) were associated with all-cause mortality. Men reporting no exercise had a risk of death ≥3 times that of men who exercised 3 or more times per week (OR=3.26, CI: 1.90 - 5.61). Ever having consumed alcohol was associated with reduced all-cause risk of death (OR=0.61, CI: 0.41 - 0.89).

Conclusions: Factors independent of disease and treatment modify adult survivors' risk of death. Even at this preliminary stage, our findings can inform screening, surveillance, and intervention strategies aimed at reducing the risk of premature mortality in this group.

Learning Areas:
Chronic disease management and prevention
Public health or related nursing
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the impact of health concerns, self-rated health status, lifestyle/health behavior, and medical care utilization on mortality in adult survivors of childhood cancer. Differentiate between those factors that increase or reduce mortality. Describe how these factors can inform counseling and intervention strategies to reduce the risk of premature mortality in this population.

Keywords: Mortality, Health Risks

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator on multiple federally-funded grants focusing on health promotion and disease prevention in the general population and in adult survivors of childhood cancer. My interests have included the development of instrumentation to measure and intervention strategies to support motivation for health promotion activities. I am currently conducting two randomized controlled clinical trials targeting health promotion in childood cancer survivors.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.