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Use of appropriate initial treatment among adolescents and young adults with cancer
Arnold L Potosky1, Linda C Harlan2, Karen Albritton2
1Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW). alp49@georgetown.edu.
Background:
There has been little improvement in the survival of adolescent and young adult (AYA) cancer patients aged 15 to 39 years relative to other age groups, raising the question of whether such patients receive appropriate initial treatment.
Methods:
We examined receipt of initial cancer treatment for a population-based sample of 504 AYAs diagnosed in 2007-2008 with acute lymphoblastic leukemia (ALL), Hodgkin's or non-Hodgkin's lymphoma, germ cell cancer, or sarcoma. Registry data, patient surveys, and detailed medical record reviews were used to evaluate the association of patient demographic, socioeconomic, and health care setting characteristics with receipt of appropriate initial treatment, which was defined by clinical specialists in AYA oncology based on adult guidelines and published literature available before 2009 and analyzed with multivariable logistic regression. All statistical tests were two-sided.
Results:
Approximately 75% of AYA cancer patients in our sample received appropriate treatment, 68% after excluding stage I male germ cell patients who all received appropriate treatment. After this exclusion, appropriate treatment ranged from 79% of sarcoma patients to 56% of ALL patients. Cancer type (P < .01) and clinical trial participation (P = .04) were statistically significantly associated with appropriate treatment in multivariable analyses. Patients enrolled in clinical trials were more likely to receive appropriate therapy relative to those not enrolled (78% vs 67%, adjusted odds ratio = 2.6, 95% confidence interval = 1.1 to 6.4).
Conclusions:
Except for those with early stage male germ cell tumors, approximately 30% (or 3 in 10) AYA cancer patients did not receive appropriate therapy. Further investigation is required to understand the reasons for this potential shortfall in care delivery.
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