Delivery of Guideline Concordant Supportive Care for AYAs with Cancer in a Statewide Population-Based Cohort

In the past two decades, there has been a growing recognition of the unique needs of adolescent and young adult (AYA) cancer patients. Alongside this recognition is the emergence of guidelines for high-quality AYA cancer care. Despite such tailored guidelines, preliminary studies suggest a gap between recommended versus received care among AYAs. We sought to examine patterns in receipt of guideline-concordant care among this population using a state-wide claims database.

We conducted a retrospective cohort study using the Cancer Information and Population Health Resource, a linkage of North Carolina claims data and cancer registry data, to examine receipt of guideline-concordant care among patients ages 13-39 years with seven of the most common AYA cancer types. We explored differences in receipt of care by clinical and sociodemographic factors and conducted multivariate logistic regression incorporating both patient and provider-level variables to evaluate care delivery.

Across these measures of guideline-concordant care-fertility preservation (13%), psychosocial/mental health care (37%), and palliative care (45%), documented receipt was observed in less than half of the cohort. Differences in receipt of guideline-concordant care emerged across sociodemographic and clinical characteristics, including higher frequency of fertility preservation for adolescents (adjusted Risk Ratio [aRR] 1.76), lower rates for rural patients (aRR 0.40), and lower rates of mental health care for Black (aRR 0.61) and Hispanic (aRR 0.63) AYAs.

In our cohort, guideline-concordant care was delivered inconsistently across a statewide AYA cancer population. These findings reaffirm the need for continued efforts to integrate fertility preservation, mental health, and palliative care into care delivery for AYAs. Further system- and provider-level efforts are needed to ensure guideline-concordant care is delivered equitably across clinical and sociodemographic groups.