Long‐term survival among 5‐year survivors of adolescent and young adult cancer

Abstract

BACKGROUND: Although there are a growing number of survivors of adolescent and young adult (AYA) cancer, to the authors' knowledge the long-term overall survival (OS) patterns for AYA cancer survivors are underreported. The objective of the current study was to assess the long-term survival of AYA cancer survivors and identify factors associated with diminished long-term survival. METHODS: The authors used The University of Texas MD Anderson Cancer Center's tumor registry to identify 5-year survivors of cancer diagnosed as AYAs (ages 15-39 years) between the years 1970 and 2005, and who were alive 5 years after diagnosis. Kaplan-Meier curves were used to estimate OS rates over time, and Cox proportional hazards models were fitted to evaluate the association of covariates with OS. RESULTS: The authors identified 16,728 individuals who were 5-year survivors of cancer and were diagnosed as AYAs with a median follow-up of 20.0 years. The 10-year, 20-year, and 25-year OS rates were 86% (95% confidence interval [95% CI], 85%-86%), 74% (95% CI, 73%-75%), and 68% (95% CI, 67%-68%), respectively, all of which were lower than the age-adjusted estimated survival rates of the general population. Long-term OS improved for AYAs diagnosed between 2000 and 2005 compared with those diagnosed in the prior decades (P < .001). Older age at the time of diagnosis, receipt of radiation, and diagnoses including central nervous system tumors and breast cancer each were associated with diminished long-term survival. CONCLUSIONS: AYA cancer survivors have inferior long-term survival compared with the general population. Studies investigating the prevalence and types of late treatment effects and causes of death among AYA survivors are needed to more accurately identify AYAs who are at highest risk of early or late mortality.

Incidence, Survival, and Mortality Trends of Cancers Diagnosed in Adolescents and Young Adults (15–39 Years): A Population-Based Study in The Netherlands 1990–2016

“…As in previous studies, survival outcomes in the past (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) were around 6% higher in female AYAs, but have become approximately equal between both sexes in 2010-2016 [12,14,55]. Lower survival outcomes among male AYAs in the past have been attributed to the increased burden of cancers related to the HIV/AIDS epidemic, which mainly affected males and historically had among the lowest survival outcomes (Kaposi sarcoma) [9].…”

“…Favourably high survival outcomes and promising gains among AYA cancer patients have been reported by multiple studies worldwide and now often exceed well above 80% (here 86.4% in 2010–2016) at five-years of follow-up [ 12 , 24 , 25 , 55 ]. As noted in a recent study, AYAs now demonstrate survival gains that are at least equal to those found in paediatric and older adult patient populations and it was concluded that the AYA survival gap has been closed.…”

“…[ 7 , 12 , 14 ]. Likewise, reported gains in 10-, 20-, and 25-year overall survival among five-year American AYA cancer survivors (treated between 1970–2005) remained overall inferior to that of the general population [ 55 ]. Survival outcomes among AYAs might in fact also be less favourable than those reported in the literature due to being artificially inflated by thyroid carcinoma overdiagnosis (five-year survival approaches 100%).…”

Comparison of survival between adolescent and young adult vs older patients with hepatocellular carcinoma

“…AYA cancer survivors have an inferior 5-year OS compared with the general population, while the long-term survival of AYA cancer survivors has improved[ 17 ]. However, the improvements of the survival rate and mortality of AYA cancer patients are not as good as those of younger or older patients, mainly because past oncologists and researchers did not pay attention to AYA cancer patients and there are few clinical studies on them[ 18 , 19 ].…”

A 3-month Journey: The Case of a 29-year Old Woman With Metastatic Renal Cell Carcinoma

“…3 Due to delays in diagnosis and other biological factors, the 5-year survival for this cohort has stayed stagnant over the years despite improvements in the survivorship profile for pediatric and older adult cancer populations. 4-6…”