Does Joint Care Impact Teenage and Young Adult's Patient-Reported Outcomes After a Cancer Diagnosis? Results from
Lorna A Fern1, Elysse Bautista-Gonzalez2, Julie A Barber3
1Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK.
Background:
Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYA:16-24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as 'joint care' with designated hospitals (DHs). We examined whether joint care impacted patient-reported outcomes when compared to care at one site.
Methods:
A cross-sectional survey was conducted in England, Scotland, and Wales. This included validated measures of quality of life (QoL), anxiety and depression, health status, social support, and illness perception. Comparisons were made based on young people's exposure to specialist care within 6 months of diagnosis, defined as care in a TYA PTC: all-TYA-care (all care in a TYA unit), no-TYA-care (no care in a TYA unit, care delivered in a children's/adult unit only), and joint-care (care in a TYA-PTC and in a children's/adult unit).
Results:
Overall, 260/1009 (25.8%) participants responded (England n = 241; Scotland/Wales n = 19). Due to different healthcare policies, statistical analysis was applied to England only. Mean QoL scores were <69.7, the threshold indicating impaired QoL (mean 58.65, standard deviation 20.13). After adjustment for confounding factors, no clinically significant differences in mean QoL between categories existed. The adjusted mean difference for all-TYA-care (n = 66) versus no-TYA-care (n = 89) was -2.28 units (95% confidence interval (CI: -8.85 to 4.29) and for joint-care versus no-TYA-care (n = 85), -4.35 units (CI: -10.34 to 1.63). Similarly, no notable differences in social support, anxiety, depression, or illness perception between categories existed. Patients receiving all-TYA-care had a lower average health status compared with no-TYA-care (difference in means -0.09 (CI:-0.18 to -0.01).
Conclusions:
No evidence that patient-reported outcomes differ by categories of care existed. This may suggest the evolution of TYA cancer services has led to similar outcomes regardless of care category. However, given the small sample size it is not possible to draw firm conclusions.
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