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Beyond childhood: exploring the state of transitional care in pediatric pilocytic astrocytoma
Katherine Chandler1, Vivek A Pisharody1, Julia Grigorian1
11Emory University School of Medicine, Atlanta.
Insights
Only 17.5% of pediatric pilocytic astrocytoma (PPA) patients successfully transition to adult care. This highlights a need for improved long-term care strategies for PPA survivors transitioning from pediatric to adult services.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Transition of Care
Background:
- Pediatric pilocytic astrocytoma (PPA) requires long-term monitoring.
- The transition process for PPA patients from pediatric to adult care is not well understood.
- Improved characterization of this transition is needed to optimize long-term management.
Purpose of the Study:
- To examine the clinical course of pediatric pilocytic astrocytoma (PPA) patients.
- To evaluate the transition of PPA patients to adult care.
- To identify areas for improvement in long-term care for PPA survivors.
Main Methods:
- Retrospective review of 315 pediatric PPA patients (diagnosed <18 years) from May 2000 to November 2022.
- Extracted demographics, tumor characteristics, recurrence, therapies, and follow-up data.
- Analyzed adult follow-up notes for patients aged 18+ by January 2024.
Main Results:
- Gross-total resection (GTR) was achieved in 59.4% of patients, associated with lower recurrence rates (8.6% vs 41.4%).
- Only 17.5% of 177 age-eligible patients successfully transitioned to adult care.
- Transitioned patients had longer follow-up (12.5 vs 7.0 years) and older diagnosis age (12.1 vs 9.6 years).
Conclusions:
- A low rate of successful transition to adult care was observed for pediatric pilocytic astrocytoma (PPA) patients.
- Opportunities exist to enhance the transition process, especially for non-GTR cases.
- Long-term follow-up is crucial, particularly within the first 10 years post-diagnosis.
Objective:
Pediatric pilocytic astrocytoma (PPA) requires prolonged follow-up after initial resection. The landscape of transitional care for PPA patients is not well characterized. The authors sought to examine the clinical course and transition to adult care for these patients to better characterize opportunities for improvement in long-term care.
Methods:
Pediatric patients (younger than 18 years at diagnosis) who underwent biopsy or resection for PPA between May 2000 and November 2022 at the authors' large academic center were retrospectively reviewed. Patient demographics, tumor characteristics, recurrence, adjuvant therapies, and follow-up data were extracted from the electronic medical record via chart review. Charts of patients who were 18 years or older as of January 1, 2024, were reviewed for adult follow-up notes.
Results:
The authors identified 315 patients who underwent biopsy or resection for PPA between May 2000 and November 2022. The most common tumor location was posterior fossa (59.7%), and gross-total resection (GTR) was achieved in 187 patients (59.4%). In patients with GTR, progression/recurrence occurred less frequently (8.6% vs 41.4%, p < 0.01) compared to patients with non-GTR. Among 177 patients found to be age-eligible for transition to adult care, the authors found that 31 (17.5%) successfully transitioned. The average age at transition from pediatric to adult care was 21.7 years, and the average age at last known adult follow-up was 25.0 years. The authors found that patients who transitioned to adult care were followed longer (12.5 vs 7.0 years, p < 0.01) and were diagnosed at an older age (12.1 vs 9.6 years, p < 0.01) than their untransitioned counterparts.
Conclusions:
The authors found that there was a low rate of successful transition from pediatric to adult care for PPA; 17.5% of age-eligible patients are now cared for by adult providers, whereas an additional 18.6% completed appropriate follow-up during childhood and did not require transition to adult care. These findings underscore opportunities for improvement in the pediatric-to-adult transition process for patients with PPA, particularly for those with non-GTR who were not followed for at least 10 years, during which the risk of disease progression is thought to be highest.
