Evaluation of the effect of care at NCI comprehensive cancer centers (NCICCCs) on disparities in outcome within adolescents and young adults (AYAs) with cancer.

Abstract

9512 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21 year-olds, the impact of site of care on survival for vulnerable AYA subpopulations (age at diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains unstudied. Methods: We constructed a cohort of 10,727 patients newly diagnosed between the ages of 22- and 39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the LA County cancer registry between 1998 and 2008. Multivariable Cox regression analysis was conducted, and included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model; the analysis was stratified by site of care (NCICCC vs. non-NCICCC). Results: A total of 928 (9%) patients received treatment at the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer Center) in LA County, and 9,799 received care elsewhere. Five-year overall survival (5y OS) was significantly worse for patients treated at non-NCICCC (87%) when compared with those treated at NCICCC (84%, p=0.02). In addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic whites (89%, p<0.0001) and for older patients (31-39yo: 84%, vs. 22-30yo: 86%, p=0.0004). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that African Americans (HR=1.4, p=0.0002) and older AYAs (31-39y: HR=1.24, p<0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (African Americans: HR=0.8, p=0.7) and age (31-39yo: HR=1.1, p=0.6) was abrogated. On the other hand, among patients treated at non-NCICCC, these differences in outcome persisted (African Americans: HR=1.45, p =0.0002; 31-39yo: HR=1.25, p<.0001). Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the effects of race and older age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs are being explored.

Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988–2011: a population‐based study

“…Other factors that may contribute to the worse outcomes among older patients with AML include the lower participation of adolescents and young adults in clinical trials or treatment at hospitals that are not affiliated with NCI-designated cancer centres compared with that of paediatric patients (Bleyer & Barr, 2009). We had no information on patients' clinical trial enrolment, but our observations support the results from a previous study (Wolfson et al, 2012) showing that adolescents and young adults with cancer who were treated at hospitals affiliated with NCI-designated cancer centres had better outcomes than those treated at hospitals not affiliated with such centres.…”

“…Our analyses investigated how the following variables representing sociodemographic and clinical characteristics were associated with early death and overall survival: age at diagnosis, treatment period, sex, race/ethnicity, neighbourhood SES, health insurance status, and treatment facility. All of the variables considered had a priori hypothesized or previously observed (Bradley et al, 2011;Walter et al, 2011;Wolfson et al, 2012;Pulte et al, 2013;Patel et al, 2015a;Percival et al, 2015) associations with early death or survival. We also hypothesized that sociodemographic factors would have a greater impact on survival in older versus younger patients and investigated this hypothesis by analysing the hazard of death by age group.…”

Assessing translational research excellence in European comprehensive cancer centers

“…how to define success in translational research (bench to bedside and back) in terms of practice-changing innovations [32] The awareness that alignment between research and clinical areas is essential in successful translational research [33] can explain why more mixed assessments are being introduced in the EU. This is comparable to the SPORE [34]…”

Children, Adolescents, and Young Adults With Leukemia: The Empty Half of the Glass Is Growing

“…This is a positive trend, given the consistent finding in both the United States and Western Europe that older adolescents with ALL enrolled onto pediatric ALL trials fare better than those enrolled onto adult ALL trials. [3][4][5][6] This is borne out further by the substantial differences in outcome for older adolescents that we reported as compared with SEER data from the same eras. 2,7 We are encouraged by the adoption of pediatric ALL regimens by adult cooperative groups for older adolescents and young adults, an effort in which Stock has been an international leader.…”

“…In Los Angeles County, AYAs with cancer who were not treated at National Cancer Institute-designated centers between 1998 and 2008 had a statistically significantly worse 5-year survival than those who were. 6 The challenge is not limited to AYAs, however, given that children not seen at COG centers with a childhood cancer also do not do as well. 7 Hunger et al 1 state that optimal treatment for an older adolescent with ALL is referral to a pediatric center and enrollment onto a pediatric cooperative group trial.…”