Higher general practice-reported health condition rates among adolescent and young adult (18−39 years) cancer survivors up to 22 years after diagnosis in the Netherlands: a retrospective cohort study.

Background
Knowledge about survivorship-related health effects in Adolescents and Young Adults (AYAs) remains limited. This study aimed to investigate the number and types of long-term and late general practice-reported health conditions among AYA cancer survivors compared to matched controls up to 22 years post-diagnosis, using national cancer registry and routinely recorded general practice health data. Additionally, we explored possible demographic-, tumour-, and treatment-related determinants for having any health condition among AYA cancer survivors.

Methods
Demographic, tumour and treatment data of AYAs (18–39 years) diagnosed with a malignant tumour in the Netherlands between 1999–2020 were retrieved from the Netherlands Cancer Registry. Routinely recorded general practice health data were retrieved from the Nivel Primary Care Database. With a minimum follow-up time of one year, comparison of reported health conditions among AYA survivors with matched controls and exploration of determinants among AYA survivors was done with negative binomial regression analysis.

Results
A total of n = 3,347 AYA survivors were matched to n = 10,041 controls (1:3 ratio). AYA survivors more often consulted their general practitioner (GP) regardless of follow-up time and attained age in most situations. Overall, AYA survivors were 1.3-times more likely to consult their GP for any health condition. Additional risk ranged from 1.1-times for musculoskeletal and eye conditions to 13.6-times for malignancy-related conditions. In contrast, AYA survivors were overall 30% less likely to seek consultation for pregnancy-related conditions. Exploration of determinants showed that AYA survivors were more likely to consult their GP for any health condition if female, with higher age at diagnosis, with increased follow-up time, and if diagnosed more recently.

Conclusions
AYA survivors in the Netherlands more often consult their GP for most health condition types up to 22 years post-diagnosis, with malignancy-related conditions being the most prominent reason. Consequently, GPs play an important role in the care process of AYA cancer survivors.