Do survivors of adolescent and young adult cancer value follow-up cancer care?

8 Background: Survivors of adolescent and young adult (AYA) cancer, diagnosed between the ages of 15-39, require life-long medical care. Cost is a known barrier. However, survivors' valuation of follow-up care has not been investigated. We used willingness to pay (WTP), an economic tool for evaluating monetary values associated with medical services, to examine how survivors value follow-up care.

METHODS: AYA cancer survivors ≥18 years of age who had completed their primary therapy were identified by the Utah Cancer Registry. Of 137 randomly-selected survivors, 64 agreed to be contacted; 32 participated. We conducted 6 focus groups and 4 interviews from April-August 2015. Participants filled out a mini-survey, discussed cancer-related follow-up care, and responded to WTP questions. Focus group transcripts were coded in NVivo by 2 researchers (percent agreement = 97.8%). An interval regression identified factors associated with higher WTP.

RESULTS: 56% of participants were females and average age was 31 years. Over 45% reported ≥1 day of poor physical health in the previous month, with 15% reporting ≥10 days. Yet, 28% and 10% had no routine follow-up visit with a doctor in the previous 1-2 and 2-5 years, respectively. Focus group coding suggested that survivors valued follow-up care for early detection and management of health conditions, although this decreased over time because of other responsibilities (e.g., college/work/family), they felt the medical visits were costly/ineffective, and because they lacked easy access to specialists. WTP analysis showed that married survivors were willing to pay $456 more for an annual follow-up visit than never-married/single/separated (p = .05). Those with recent checkups were willing to pay more than others (p = .07). Insurance did not affect WTP.

CONCLUSIONS: Targeted survivorship care strategies are needed to address the needs of AYA cancer survivors who are at risk for skipping follow-up care. Survivors with no recent medical visits or who are not married need additional support.