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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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Research Articles

Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer

Xiao-Cheng Wu, Pinki K. Prasad, Ian Landry, Linda C. Harlan, Helen M. Parsons, Charles F. Lynch, Ashley W. Smith, Ann S. Hamilton and Theresa H.M. Keegan
Xiao-Cheng Wu
1Department of Epidemiology, LSUHSC, New Orleans, Louisiana.
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  • For correspondence: xwu@lsuhsce.du
Pinki K. Prasad
2Department of Pediatric Hematology/Oncology, LSUSHC/Children's Hospital of New Orleans, New Orleans, Louisiana.
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Ian Landry
1Department of Epidemiology, LSUHSC, New Orleans, Louisiana.
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Linda C. Harlan
3Applied Research Program, National Cancer Institute, Bethesda, Maryland.
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Helen M. Parsons
4University of Texas Health Science Center, San Antonio, Texas.
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Charles F. Lynch
5Department of Epidemiology, University of Iowa, Iowa City, Iowa.
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Ashley W. Smith
6Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
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Ann S. Hamilton
7Preventive Medicine, University of Southern California Norris Cancer Center, Los Angeles, California.
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Theresa H.M. Keegan
8Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, California.
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DOI: 10.1158/1055-9965.EPI-15-0401 Published December 2015
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  • Table 1.

    Characteristics of AYA HOPE participants

    Frequency%
    Sociodemographic variables
     Age at diagnosis, y
      15–196212.8
      20–2921143.5
      30–3921243.7
     Sex
      Male30362.5
      Female18237.5
     Race/ethnicity
      White39481.2
      Black398.0
      Asian367.4
      Unknowna 163.3
     Health insurance status
      Yes44291.1
      No367.4
      Unknown71.5
     Service needed
      Nurse comes to home
       Yes306.2
       No43489.5
       Unknown214.3
      Support groups
       Yes8617.7
       No37477.1
       Unknown255.2
      Mental health services
       Yes12225.2
       No34170.3
       Unknown224.5
      Physical/occupational therapy
       Yes6814.0
       No39180.6
       Unknown265.4
      Pain management specialist
       Yes5912.2
       No40483.3
       Unknown224.5
      Any service needed
       Yes19239.6
       No29360.4
    Clinical variables
     Health status
      Good/very good/excellent40483.3
      Fair/poor8116.7
     Cancer type
      Germ cell tumor18939.0
      Hodgkin lymphoma13427.6
      Leukemia214.3
      Non-Hodgkin lymphoma11724.1
      Sarcoma245.0
     Cancer stage
      All cancers combined
       Stage I16133.2
       Stage II13928.7
       Stage III6613.6
       Stage IV5010.3
       Unknown6914.2
     Treatment received
      Surgery
       Yes5912.2
       No42687.8
      Radiation
       Yes5210.7
       No43389.3
      Chemotherapy
       Yes23849.1
       No24750.9
    • ↵aUnknown race includes selections for American Indian/Alaskan Native.

  • Table 2.

    Frequency (n) and percentage of comorbidities in AYA HOPE participants, by comorbidity index

    Comorbidity index
    AYA HOPECharlsonNCI
    n (%)n (%)n (%)
    Comorbidity categories
     Cardiovascular30 (6.2)12 (2.5)b
     Diabetes18 (3.7)18 (3.7)18 (3.7)
     Endocrine10 (2.1)b a
     Gastrointestinal20 (4.1)6 (1.2)5 (1.0)
     HIV/AIDS18 (3.7)18 (3.7)18 (3.7)
     Hypertension29 (6.0)29 (6.0)a
     Liver13 (2.7)13 (2.7)13 (2.7)
     Mental health40 (8.2)a a
     Neurologic42 (8.7)b b
     Obesity/overweight28 (5.8)a a
     Renal5 (1.0)b b
     Asthma/respiratory30 (6.1)30 (6.1)30 (6.1)
     Rhematologic/autoimmune5 (1.0)5 (1.0)5 (1.0)
     Hematologicb a a
    Distribution of number of comorbidities
     0320 (66.4)381 (78.6)406 (83.7)
     194 (19.4)80 (16.5)66 (13.6)
     ≥271 (14.6)24 (4.9)13 (2.7)

    NOTE: All indices are shown unweighted for accurate frequency comparisons.

    • ↵aThe index does not include this comorbid condition.

    • ↵bSuppressed because of fewer than 5 cases with this comorbid condition.

  • Table 3.

    Multivariable adjusted ORs and 95% CIs for each of the services needed and health status, by comorbidity index

    Comorbidity countAYA HOPEbCharlsonbNCIb
    Service needed/health statusaOR (95% CI)OR (95% CI)OR (95% CI)
    Nurse come to home
     01.001.001.00
     11.37 (0.53–3.53)1.10 (0.39–3.08)1.65 (0.62–4.35)
     ≥21.20 (0.40–3.57)2.44 (0.63–9.37)c
    Support group
     01.001.001.00
     11.06 (0.55–2.03)1.53 (0.82–2.88)1.15 (0.57–2.29)
     ≥21.56 (0.80–3.05)0.86 (0.28–2.61)0.64 (0.12–3.34)
    Mental health services
     01.001.001.00
     11.62 (0.93–2.84)2.01 (1.14–3.53) 2.26 (1.24–4.11)
     ≥22.05 (1.10–3.82) 1.53 (0.58–4.00)0.68 (0.16–2.86)
    Physical/occupational therapy
     01.001.001.00
     11.08 (0.54–2.17)1.43 (0.72–2.84)1.55 (0.75–3.18)
     ≥21.12 (0.50–2.44)1.21 (0.39–3.79)0.70 (0.13–3.75)
    Pain management specialist
     01.001.001.00
     12.56 (1.30–5.04) 2.18 (1.09–4.37) 2.07 (1.00–4.27)
     ≥21.75 (0.78–3.92)1.84 (0.60–5.67)0.48 (0.05–4.08)
    Health status
     01.001.001.00
     11.70 (0.87–3.33)2.35 (1.23–4.52) 3.17 (1.61–6.26)
     ≥23.16 (1.58–6.33) 5.59 (2.05–15.2) 8.88 (2.44–32.3)

    NOTE: Significant ORs and 95% CI are in bold.

    • ↵aService needed: yes versus no; health status: fair/poor versus good/very good/excellent.

    • ↵bModels are adjusted for both clinical factors (i.e., cancer type, health status, treatment) and demographic factors (i.e., age, sex, and race/ethnicity).

    • ↵cNot able to get statistics because of small number of cases.

Additional Files

  • Tables
  • Supplementary Data

    • AYA HOPE Comorbidity supplemental table - List of specific conditions in the AYA HOPE comorbidity index
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Cancer Epidemiology Biomarkers & Prevention: 24 (12)
December 2015
Volume 24, Issue 12
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Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer
Xiao-Cheng Wu, Pinki K. Prasad, Ian Landry, Linda C. Harlan, Helen M. Parsons, Charles F. Lynch, Ashley W. Smith, Ann S. Hamilton and Theresa H.M. Keegan on behalf of AYA HOPE Study Collaborative Group
Cancer Epidemiol Biomarkers Prev December 1 2015 (24) (12) 1844-1849; DOI: 10.1158/1055-9965.EPI-15-0401

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Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer
Xiao-Cheng Wu, Pinki K. Prasad, Ian Landry, Linda C. Harlan, Helen M. Parsons, Charles F. Lynch, Ashley W. Smith, Ann S. Hamilton and Theresa H.M. Keegan on behalf of AYA HOPE Study Collaborative Group
Cancer Epidemiol Biomarkers Prev December 1 2015 (24) (12) 1844-1849; DOI: 10.1158/1055-9965.EPI-15-0401
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