From active treatment to long-term cancer survivorship – Understanding how care patterns drive adherence to surveillance and screening guidelines

PROJECT ABSTRACT Administrative Supplements on Long-term Cancer Survivorship: The number of young adult cancer survivors continues to grow, yet many face healthcare navigation issues stemming from insurance-related challenges, financial toxicity and care fragmentation. If unresolved, these issues can lead to loss of follow-up and inadequate long-term cancer surveillance and screening during the survivorship phase. To address this, navigation support interventions, such as CHAT-S, a virtual insurance program tested in the parent award (R01276825), can be deployed as young adult cancer survivors transition to the survivorship phase to maintain continuity of care. Understanding care patterns during and immediately after primary treatment can assist to refine the implementation of such interventions to improve long-term survivorship outcomes, including surveillance for cancer recurrence and screening for second cancers. Therefore, the aim of our proposed project is to evaluate how care patterns during and immediately after primary treatment may differ between young adult cancer survivors who received recommended long-term surveillance care and screening for second cancers starting 5 years after diagnosis and those who did not. Specifically, we will examine two types of care patterns: (i) how young adult cancer patients engage the healthcare system while receiving treatment (care engagement patterns) (Specific Aim 1) and (ii) how care management is structured as young adult cancer patients transition to the survivorship phase (care management patterns) (Specific Aim 2). To do this, we will leverage a statewide longitudinal cohort of 6,600 young adult cancer survivors with data linkages to statewide hospitalization, emergency department, and claims data. Care engagement patterns will be identified using a latent profile analysis of healthcare resource utilization indicators during active treatment, namely treatment non-adherence, emergency/urgent care use and unplanned hospitalizations. Care management patterns will be assessed using social network analysis metrics, which are primarily measured based on shared patients between provider pairs and represent care coordination and communication within each patient’s clinical care team. The association of both types of care patterns and receipt of recommended long- term surveillance care and screening for second cancers will be then evaluated using multivariable logistic regression. Proposed work under this supplement builds on the parent award (R01276825) as our findings will identify patient subgroups that will benefit the most from CHAT-S and inform future iterations of the intervention. In the long term, this proposed research will guide the development of other navigation support tools that will improve adherence and facilitate transition of care among young adult cancer survivors. Given the study team’s analytical expertise and existing access to the required dataset, the proposed work is feasible to complete within the 1-year supplement period.