Use of appropriate initial treatment among adolescents and young adults with cancer

Arnold L Potosky; Linda C Harlan; Karen Albritton; Rosemary D Cress; Debra L Friedman; Ann S Hamilton; Ikuko Kato; Theresa H M Keegan; Gretchen Keel; Stephen M Schwartz; Nita L Seibel; Margarett Shnorhavorian; Michele M West; Xiao-Cheng Wu; AYA HOPE Study Collaborative Group

doi:10.1093/jnci/dju300

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Use of appropriate initial treatment among adolescents and young adults with cancer

Journal article

Open access

Peer reviewed

Use of appropriate initial treatment among adolescents and young adults with cancer

Arnold L Potosky, Linda C Harlan, Karen Albritton, Rosemary D Cress, Debra L Friedman, Ann S Hamilton, Ikuko Kato, Theresa H M Keegan, Gretchen Keel, Stephen M Schwartz, …

JNCI : Journal of the National Cancer Institute, Vol.106(11), p.1

11/2014

DOI: 10.1093/jnci/dju300

PMCID: PMC4200030

PMID: 25301964

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Abstract

There has been little improvement in the survival of adolescent and young adult (AYA) cancer patients aged 15 to 39 years relative to other age groups, raising the question of whether such patients receive appropriate initial treatment. We examined receipt of initial cancer treatment for a population-based sample of 504 AYAs diagnosed in 2007-2008 with acute lymphoblastic leukemia (ALL), Hodgkin's or non-Hodgkin's lymphoma, germ cell cancer, or sarcoma. Registry data, patient surveys, and detailed medical record reviews were used to evaluate the association of patient demographic, socioeconomic, and health care setting characteristics with receipt of appropriate initial treatment, which was defined by clinical specialists in AYA oncology based on adult guidelines and published literature available before 2009 and analyzed with multivariable logistic regression. All statistical tests were two-sided. Approximately 75% of AYA cancer patients in our sample received appropriate treatment, 68% after excluding stage I male germ cell patients who all received appropriate treatment. After this exclusion, appropriate treatment ranged from 79% of sarcoma patients to 56% of ALL patients. Cancer type (P < .01) and clinical trial participation (P = .04) were statistically significantly associated with appropriate treatment in multivariable analyses. Patients enrolled in clinical trials were more likely to receive appropriate therapy relative to those not enrolled (78% vs 67%, adjusted odds ratio = 2.6, 95% confidence interval = 1.1 to 6.4). Except for those with early stage male germ cell tumors, approximately 30% (or 3 in 10) AYA cancer patients did not receive appropriate therapy. Further investigation is required to understand the reasons for this potential shortfall in care delivery.

Registries

United States

Adolescent

Adult

Female

Germinoma - therapy

Hodgkin Disease - therapy

Humans

Logistic Models

Lymphoma, Non-Hodgkin - therapy

Male

Neoplasms - therapy

Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy

Quality of Health Care - standards

Retrospective Studies

Sarcoma - therapy

SEER Program

Young Adult

Details

Title: Subtitle: Use of appropriate initial treatment among adolescents and young adults with cancer
Creators: Arnold L Potosky - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW). alp49@georgetown.edu
Linda C Harlan - National Institutes of Health
Karen Albritton - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Rosemary D Cress - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Debra L Friedman - Boston Children's Hospital
Ann S Hamilton - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Ikuko Kato - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Theresa H M Keegan - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Gretchen Keel - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Stephen M Schwartz - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Nita L Seibel - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Margarett Shnorhavorian - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
Michele M West - University of Iowa, Epidemiology
Xiao-Cheng Wu - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW)
AYA HOPE Study Collaborative Group
Resource Type: Journal article
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.106(11), p.1
DOI: 10.1093/jnci/dju300
PMID: 25301964
PMCID: PMC4200030
NLM abbreviation: J Natl Cancer Inst
ISSN: 0027-8874
eISSN: 1460-2105
Publisher: Oxford University Press
Grant note: P30CA051008 / NCI NIH HHS P30 CA086862 / NCI NIH HHS P30 CA051008 / NCI NIH HHS
Language: English
Date published: 11/2014
Academic Unit: Epidemiology
Record Identifier: 9983996095102771

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