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Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC Irvine Electronic Theses and Dissertations (2024)

Given significant advancements in cancer treatment, close to 85% of children and adolescents diagnosed with cancer have long-term survival. In the United States, there are approximately 500,000 childhood cancer survivors looking forward to many years ahead. Yet, the aftermath of cancer poses substantial challenges, including cancer-related late effects, psychosocial struggles, and financial burdens. The objective of this dissertation is to further our understanding of life milestones (e.g., employment, educational attainment, living arrangement, relationship status) and cancer-related late effects among Young Adult Childhood Cancer Survivors (YACCS) using a population-based sample from the Los Angeles Cancer Surveillance Program, the Surveillance, Epidemiology, and End Results (SEER) Cancer Registry covering Los Angeles County.Study 1 aimed to examine the prevalence of life milestones among YACCS and non-cancer population-based cohort controls. The study conducted a matched-cohort case control to compare YACCS and a non-cancer comparison group from the California Health Interview Survey (CHIS) (matched by age, sex, year of survey, and race/ethnicity) on the prevalence of life milestones (e.g., full-time employment, educational attainment, living independently, relationship status). The results showed that YACCS were less likely to have a college degree, have a full-time employment, and married/partnered compared to their peers without a cancer history. In contrast, they were more likely to be unemployed, have a part-time employment, and live with a parent. The objective of study 2 was to assess the relationship between delays in achieving life milestones and depressive symptoms over time in YACCS. The study used linear regression model with depressive symptoms as the outcome variable and delay in life milestone as the exposure variable. Delays in educational attainment was a significant predictor of depressive symptoms, even when demographic factors and baseline depressive symptoms were controlled. The aim of study 3 was to identify the subgroups of YACCS based on their cancer-related late effects and how each subgroup is associated with life milestone achievement. The study used latent class analysis and logistic regression models. The latent class analysis revealed multimorbidity group and resilient group based on cancer-related late effects reported by the survivors. The multimorbidity group were less likely to have a college degree and be employed full-time compared with the resilient group after adjusting for demographic factors, years since diagnosis, and treatment intensity. This research is a population-based study that utilizes a diverse sample of recently treated YACCS in Los Angeles County. It offers valuable insights into their post-cancer experiences during a period marked by medical and treatment advancements in childhood cancers. The significance of this research lies in its potential to positively impact cancer survivorship research by enhancing our understanding of the risk and protective factors that affect the achievement of life milestones among YACCS. It also offers a window into the long-term effects of childhood cancer on the social determinants of health and wellbeing. The findings from this study not only contribute to the existing body of knowledge but also lay the groundwork for future research aimed at developing targeted interventions. These interventions will be tailored to the age-specific needs of survivors, focusing on promoting social integration and independence, which are pivotal in securing a high-quality survivorship experience.

    Cover page: Life Milestones and Cancer-related Late Effects among Young Adult Survivors of Childhood CancersCreative Commons 'BY-ND' version 4.0 license
    • Article
    • Peer Reviewed
    UC Irvine Previously Published Works (2023)

    Objective

    Young adult survivors of childhood cancers are less likely to be physically active compared to non-cancer affected controls, putting them at an increased risk for morbidity and mortality. Preliminary research has examined how mental health may contribute to physical activity (PA) in this population; however, those more recently diagnosed and Hispanic survivors have been understudied. The objectives were to examine associations of dimensions of depressive symptoms, demographic characteristics, and cancer-related predictors with PA among a diverse sample of young adult childhood cancer survivors.

    Methods

    Participants (N = 895) diagnosed with childhood cancer between 1996 and 2010 (53% Hispanic; Mage  = 26.2 ± 4.9 years; Mage  = 14.8 ± 4.4 years at diagnosis) were recruited from the Los Angeles County cancer registry. Self-report surveys assessed current PA, depressive symptoms (i.e., positive affect, negative affect, somatic symptoms, interpersonal problems), late effects of cancer treatment, and demographic factors. Multivariable ordinal regressions examined the study objectives.

    Results

    About 70% of participants engaged in low or moderate frequency PA (fewer than 3 days a week). Participants who were older, female, Asian, or reported more late effects of cancer treatment were less likely to engage in PA. Greater positive affect was significantly associated with higher frequency PA, whereas negative affect, somatic symptoms, and interpersonal problems were not associated with PA.

    Conclusions

    The findings suggests that positive-but not negative-mental health characteristics are more likely to facilitate or result from PA among young adult survivors of childhood cancers. Interventions seeking to increase PA may benefit from considering positive aspects of mental health/well-being.
      Cover page: Depressive symptoms and physical activity among young adult survivors of childhood cancer
      • Article
      • Peer Reviewed
      UC Irvine Previously Published Works (2021)
      Objectives: Substance use among young adult childhood cancer survivors (YACCSs) has been found to increase during survivorship, resulting in increased risk of developing long-term negative health outcomes. This investigation sought to determine various risk and protective factors of tobacco, alcohol, or marijuana use over time among a sample of YACCSs. Methods: 127 YACCSs (57% Hispanic, 55% female, average age at diagnosis 12.4 years) who were diagnosed with any cancer type (except Hodgkin lymphoma) at two large pediatric medical centers in Los Angeles County between 2000 and 2007 responded to two surveys separated by ∼5 years. Bivariate logistic regression models were used to assess independent clinical and psychosocial Time 1 variables associated with each substance use outcome at Time 2. Time 1 variables significant at p < .10 were included in multivariable logistic regression models for each Time 2 substance use variable. Results: Rates of 30-day use increased over time for binge drinking alcohol (from 25.6% to 37.7%), marijuana (from 10.6% to 22.1%), and cigarette/tobacco (from 8.9% to 12.2%). Of the following Time 1 variables, marijuana use, cigarette use, and binge drinking were associated with Time 2 marijuana, cigarette, and binge drinking, respectively. Of the following clinical factors, receipt of more intensive cancer treatment was associated with decreased tobacco use. All other psychosocial and clinical factors analyzed were not associated with any increase or decrease in substance use. Conclusions: A greater emphasis on early health education efforts regarding the health risks of tobacco, alcohol, and marijuana use is needed in this at-risk population.
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2023)
        Introduction: Survivors of colorectal cancer (CRC) are at risk for late effects of therapy and recurrence of cancer. With recurrence rates ranging between 30−40%, follow-up care is needed for both early detection and management of late effects. Cancer care delivery for CRC patients was significantly disrupted by the SARS-CoV-2 pandemic, with decreases of 40% in such services in the United States between April 2020 and 2019. Survivors were left with fewer options for care, potentially causing increases in emergency room (ER) utilization. Methods: This cross-sectional study examined the patterns of ER utilization during the SARS-CoV-2 pandemic among young adult CRC survivors and assessed the relationship between self-reported care satisfaction and ER use. Eligible participants were colon or rectal cancer survivors diagnosed between 18−39 years of age, 6−36 months from diagnosis/relapse, English speaking and residing in the United States. Multivariable logistic regression assessed the association between patient care satisfaction and ER utilization, adjusting for pandemic factors. Covariates were chosen by significance of p < 0.1 at the univariate level and perceived clinical significance. Results: The overall sample (N = 196) had mean age (SD) 32.1 (4.5); 59% were male. Tumor location was colon or rectal in 42% and 57%, respectively, and the majority (56%) were diagnosed with stage 2 disease; 42.6% reported relapsed disease, and 20% had an ostomy. Most survivors (72.5%) had between 1−4 visits to an ER in the last 12 months and were categorized as normal utilizers. Approximately 24.7% of the sample had greater than 4 visits to the ER in the last 12 months and were categorized as super-utilizers. CRC survivors that reported a delay in their follow-up care as a result of the pandemic were two times (OR: 2.05, 95% CI 0.99, 4.24) more likely to be super-utilizers of the ER. Higher self-reported satisfaction with care was associated with a 13.7% lower likelihood of being a super-utilizer (OR: 0.86, 95%CI: −0.68, 1.09). Conclusions: This study found strong associations between delays in care, self-reported care satisfaction, and being a super-utilizer of the ER during the pandemic among young adult CRC survivors off treatment. Increasing patient satisfaction and minimizing care interruptions amongst this vulnerable population may aid in mitigating over-utilization in the ER during an ongoing pandemic.
          Cover page: Patient Care Satisfaction and Emergency Room Utilization among Young Adult Colorectal Cancer Survivors during the SARS-CoV-2 Pandemic: Lessons Learned
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