Barriers to health care access, especially cost, are associated with increased odds of not having an annual physician skin examination (PSE) among young melanoma survivors, according to a research letter published online June 9 in JAMA Dermatology.

Katherine Y. Wojcik, Ph.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues examined barriers to annual PSEs among 128 young melanoma survivors (age ≤24 years at diagnosis in 1996 to 2010). Participants were asked when their last PSE occurred and what barriers to health care access they had experienced in the previous year.

The researchers found that 36 percent of participants had not received a PSE in the previous year; the likelihood of receiving a PSE was lower for Hispanic participants and those with lower socioeconomic status. Twenty-three percent of participants identified at least one barrier to accessing health services; the likelihood of having barriers was increased for survivors without PSEs versus those with PSEs (40 versus 15 percent). The most frequent barriers were financial in the total population (15 percent) and in those without versus with PSEs (30 versus 5 percent). Ten of the 15 participants who reported "it cost too much" as a barrier had no health insurance. Barriers correlated with 3.45-fold increased odds of no annual PSE.

"Owing to cost-related barriers, young melanoma survivors could benefit from patient navigation services addressing insurance issues and financial resources to improve access to annual PSEs," the authors write.

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