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Association of Guideline-Concordant Care with Survival in Adolescent and Young Adult Patients with Germ Cell Tumors
Elysia Alvarez1, Marcio Malogolowkin1, A Lindsay Frazier2
1Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA.
Purpose:
Treatment for germ cell tumors (GCTs) in adolescent and young adults (AYA: 15-39) spans different primary sites and multiple specialties. Little is known about the treatment patterns outside of clinical trials, including the delivery of guideline-concordant care.
Methods:
This is a population-based, retrospective cohort study of AYAs diagnosed (2004-2018) with GCT. Guideline-concordant care was determined using treatment text-field data from the California Cancer Registry. Survival models measured the impact of guideline-concordant care as a time-dependent variable on overall survival accounting for known prognostic factors. GCTs were analyzed separately by primary site (extragonadal, ovarian, and testicular).
Results:
The majority of patients had testicular GCT (90.4%), early-stage disease (stage I/II: 75.3%), and received part/no treatment at a specialized cancer center (SCC) (77.5%). For treatment, 37.6% of patients received surgery plus chemotherapy, followed by surgery alone (36.2%). The most common chemotherapy regimen was bleomycin, etoposide, and cisplatin. Sixty-four percent of patients received guideline-concordant care, with variations by primary site (extragonadal 54.7%, ovarian 70.1%, and testicular 64.6%). Receipt of guideline-concordant care was associated with superior survival for testicular primaries (hazard ratio = 0.56, confidence interval: 0.45-0.69). Patients with testicular primaries who had no treatment at an SCC were less likely to receive guideline-concordant care.
Conclusion:
This study identified that receipt of guideline-concordant care was associated with improved survival; however, a substantial proportion of AYA patients do not receive this care, highlighting the need to investigate the barriers to the delivery of guideline-concordant care in this patient population.
Insights
Adolescent and young adult germ cell tumor patients receiving guideline-concordant care showed improved survival. However, many patients did not receive this optimal treatment, indicating a need to address care delivery barriers.
Area of Science:
- Oncology
- Cancer Research
- Public Health
Background:
- Germ cell tumors (GCTs) affect adolescent and young adults (AYAs), with varied treatment approaches across primary sites.
- Understanding real-world treatment patterns and guideline adherence in AYAs is crucial but limited outside clinical trials.
Purpose of the Study:
- To evaluate treatment patterns and guideline-concordant care delivery for AYAs with GCTs.
- To assess the impact of guideline-concordant care on overall survival in this population.
Main Methods:
- Population-based retrospective cohort study of AYAs diagnosed with GCT between 2004-2018.
- Guideline-concordant care determined from California Cancer Registry data; survival analyzed using time-dependent models.
- GCTs analyzed separately by primary site: extragonadal, ovarian, and testicular.
Main Results:
- Most AYAs had testicular GCT (90.4%) and early-stage disease (75.3%).
- Sixty-four percent of patients received guideline-concordant care, with site-specific variations (extragonadal 54.7%, ovarian 70.1%, testicular 64.6%).
- Guideline-concordant care significantly improved survival for testicular GCTs (HR=0.56).
Conclusions:
- Receipt of guideline-concordant care is associated with improved survival in AYAs with GCTs.
- A significant proportion of AYAs do not receive guideline-concordant care, necessitating investigation into barriers.
- Optimizing care delivery at specialized cancer centers may improve outcomes for AYAs with GCTs.
