Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups

Stark, Dan; Bowen, David; Dunwoodie, Elaine; Feltbower, Richard; Johnson, Rod; Moran, Anthony; Stiller, Charles; O’Hara, Catherine

doi:10.1016/j.ejca.2015.08.010

Cited by 26 publications

(25 citation statements)

References 32 publications

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“…Also, a most recent analysis in the United Kingdom documents that sub‐groups of AYA patients with advanced solid tumors derive considerable benefit from participating in trials involving novel therapeutics . As also noted in England, however, age‐specific biology, pharmacology, proteomics, genomics, clinician and patient behavior studies embedded within clinical trials are required to further improve survival for AYAs …”

Section: Discussionmentioning

confidence: 99%

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Bleyer

Tai²,

Siegel

2018

Pediatric Blood & Cancer

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In the United States, adolescent and young adult (AYA) patients with cancer have the lowest clinical trial participation rate of all age groups and slower progress in survival improvement than younger patients. Ominously, AYA clinical trial participation has been steadily decreasing since 2010, except in 15–19 year olds and AYAs with acute lymphoblastic leukemia. In order to reverse the accrual trend, multiple changes are necessary, including convincing community oncologists to pursue clinical trials on behalf of their AYA patients and to have the new National Community Oncology Research Program and National Clinical Trials Network lead a coordinated effort to increase accrual.

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Section: Discussionmentioning

confidence: 99%

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Bleyer

Tai²,

Siegel

2018

Pediatric Blood & Cancer

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“…94,95 As noted in England, age-specific biology, pharmacology, proteomics, genomics, clinician and patient behavior studies embedded within clinical trials are required to further improve survival for AYAs. 96 …”

Section: Evidence For the Benefit Of Clinical Trials On Cancer Populamentioning

confidence: 99%

The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

Unger

Cook

Tai

et al. 2016

American Society of Clinical Oncology Educational Book

427

284

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OVERVIEW Fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. But although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and differ according to demographic and socioeconomic factors. In this paper, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer, and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared to other age groups. Our analysis suggests that a clinical trial system that enrolls patients at higher rates produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would allow trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important to patients, since trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.

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“…Survival from soft tissue sarcoma is one of the lowest of all diagnostic groups of cancers in children [26] and TYA [27] and outcomes are worse for TYA compared to children [28, 29]. Specialisation of surgical care for soft tissue sarcomas has improved outcomes for adult patients [30, 31], however little is known about the outcomes for children and TYA.…”

Section: Discussionmentioning

confidence: 99%

Access to principal treatment centres and survival rates for children and young people with cancer in Yorkshire, UK

et al. 2017

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BackgroundPrincipal Treatment Centres (PTC) were established to provide age-appropriate care as well as clinical expertise for children and young people with cancer. However, little is known about the effects of specialist treatment centres on survival outcomes especially for teenagers and young adults. This population-based study aimed to describe access to PTC and the associated trends in survival for 0–24 year olds accounting for stage of disease at presentation and treatment.MethodsPatients diagnosed from 1998–2009 aged 0–24 years were extracted from the Yorkshire Specialist Register of Cancer in Children and Young People, including information on all treating hospitals, followed-up until 31st December 2014. The six commonest cancer types were included: leukaemia (n = 684), lymphoma (n = 558), CNS tumours (n = 547), germ cell tumours (n = 364), soft tissue sarcomas (n = 171) and bone tumours (n = 163). Treatment was categorised into three groups: ‘all’, ‘some’ or ‘no’ treatment received at a PTC. Treatment at PTC was examined by diagnostic group and patient characteristics. Overall survival was modelled using Cox regression adjusting for case-mix including stage, treatment and other socio-demographic and clinical characteristics.ResultsOverall 72% of patients received all their treatment at PTC whilst 13% had no treatment at PTC. This differed by diagnostic group and age at diagnosis. Leukaemia patients who received no treatment at PTC had an increased risk of death which was partially explained by differences in patient case-mix (adjusted Hazard Ratio (HR) = 1.73 (95%CI 0.98–3.04)). Soft tissue sarcoma patients who had some or no treatment at PTC had better survival outcomes, which remained after adjustment for patient case-mix (adjusted HR = 0.48 (95%CI 0.23–0.99)). There were no significant differences in outcomes for other diagnostic groups (lymphoma, CNS tumours, bone tumours and germ cell tumours). For leukaemia patients survival outcomes for low risk patients receiving no treatment at PTC were similar to high risk patients who received all treatment at PTC, implying a benefit for care at the PTC.ConclusionThis study demonstrates that for leukaemia patients receiving treatment at a PTC is associated with improved survival that may compensate for a poorer prognosis presentation. However, further information on risk factors is needed for all diagnostic groups in order to fully account for differences in patient case-mix.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3160-5) contains supplementary material, which is available to authorized users.

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Survival patterns in teenagers and young adults with cancer in the United Kingdom: Comparisons with younger and older age groups

Cited by 26 publications

References 32 publications

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

Role of clinical trials in survival progress of American adolescents and young adults with cancer—and lack thereof

The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

Access to principal treatment centres and survival rates for children and young people with cancer in Yorkshire, UK

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