Friday, March 21, 2025
3/21/2025
Project Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 24-041.” There is an urgent need to provide high-quality survivorship care to the rapidly growing population of adolescent and young adult (AYA) cancer survivors. Approximately 90,000 AYAs are diagnosed with cancer each year. AYAs, defined as those diagnosed between 15-39 years of age, are at unique developmental life stages regarding their emotional, cognitive, and social development. A cancer diagnosis is highly disruptive to completing education, establishing families, and/or starting employment. AYA cancer survivors have enduring complex health care needs requiring coordinated care, including surveillance for cancer recurrence, management of long-term and late effects, and appropriate preventive care. However, serious gaps in care have been identified for AYA survivors, including underuse of National Comprehensive Cancer Network (NCCN) guideline-recommended cancer surveillance (e.g., mammography, colonoscopy) as well as underuse of primary care services such as vaccinations and general disease screenings. AYA survivors also experience significant disparities in care and outcomes associated with race, ethnicity, and socioeconomic status. The new National Standards for Cancer Survivorship Care provide a robust framework for developing and assessing survivorship care programs across and within U.S. healthcare systems. These standards have the potential to improve cancer survivorship care, particularly for AYA survivors given the known gaps and inequities in receipt of NCCN recommended services for cancer surveillance and preventive care. Thus, we propose to examine the recommended Health System Processes and Evaluations/Assessments as described in the National Standards for Cancer Survivorship Care in a large integrated healthcare system, Kaiser Permanente (KP). The proposed work will be a supplement to our current program grant (P01CA233432) funded through the National Cancer Institute, “Clinical Care Gaps and Unmet Needs in Adolescent and Young Adult Cancers.” The P01 provides a robust structure for the leadership, administrative, programming, and analytic needs to evaluate the National Standards via this Administrative Supplement. We will leverage our existing large contemporary cohort of AYA cancer survivors cared for within KP to: 1) Examine the availability of the new National Standards within KP; 2) Assess referral to and utilization of recommended National Standards within our KP AYA cancer survivor cohort. We will analyze receipt of referral and utilization stratified by patient demographic and cancer characteristics. The proposed study will be one of the first to assess availability, referral to and use of the National Standards for Cancer Survivorship Care in a large integrated healthcare system, with a focus on an existing diverse cohort of AYA cancer survivors. Primary findings will support future studies including examination of the National Standards in other settings, assessment of health system survivorship policies and related impacts, and development of targeted healthcare system interventions to address gaps in care.
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