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Survival Improvements for AYA Survivors Undermined by Late-Stage Diagnosis, Racial and Socioeconomic Disparities

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Key Points

  • Although dramatic increases in survival rates have been made in AYAs with cancer, most of that improvement is due to advances in the treatment for HIV/AIDS-related cancers, including Kaposi sarcoma and non-Hodgkin lymphoma.
  • Compared to white AYAs, black patients had the highest risk of dying from all cancers combined, followed by Asian-Pacific Islanders and Latino patients. For all cancers, poorer patients had an increased risk of death compared to patients in a higher socioeconomic status.
  • The greatest risk factor for death was late-stage diagnosis.

The 2006 publication of the National Cancer Institute’s report Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults With Cancer highlighted the lack of improvement in cancer survival among people between the ages of 15 and 39 compared to children and older adults with cancer. The report catapulted an effort by researchers to improve cancer survival among adolescents and young adults (AYAs).

A study evaluating survival trends in AYA survivors has found that while dramatic increases in survival rates have been made in this age group, most of that improvement is due to advances in the treatment for HIV/AIDS-related cancers, including Kaposi sarcoma and non-Hodgkin lymphoma. Survival is still worse for AYAs diagnosed with late-stage disease, for racial/ethnic minorities, and those with low socioeconomic status. The study by Moke et al is published in JNCI Cancer Spectrum.

Study Methods

The researchers analyzed data collected from the California Cancer Registry from 1988–2014 to evaluate cancer survival trends in AYAs compared to other age groups, including by disease site and subgroup, and to delineate sociodemographic subgroups of AYAs at risk for survival disparities. Twenty-two of the most common AYA cancer sites were included in the study, as well as all other invasive cancer sites and bladder cancer in situ, for a total of 23 sites.

The time period of 1988 to 2014 was divided into two intervals, 1988–2000 and 2001–2014, to allow for observation of trends over time. During that time, there were a total of 107,747 and 117,746 first cancers diagnosed among AYA California residents, respectively.

Results

To gain an overall perspective of survival trends, the researchers first compared 5-year survival improvements for AYAs to other ages. From 1988–2014, among survivors ages 30 to 34, the 5-year survival rate increased by 20.6% in males, but only 4.2% in females, and among those ages 35–39, by 18.9% in males and 4.2% in females. Among males of all ages, survival improvement was greatest for AYAs.

In contrast, when Kaposi sarcoma was excluded, survival also increased for AYA males, but not as dramatically—9.5% and 10.3% for those ages 30–34 and 35–39, respectively. Excluding Kaposi sarcoma, between 1988–2014, AYAs demonstrated a survival improvement that was larger than younger children, but similar to older adults.

For all cancers combined, AYAs had survival improvement that exceeded all other age groups, largely the result of reduced mortality from HIV/AIDS-related cancers. The strongest predictor of death was cancer stage (adjusted hazard ratio [aHR] = 6.32 for distant vs localized disease, 95% confidence interval [CI] = 6.20–6.45). The aHR of death (95% CI) was significantly higher for blacks (1.46, 1.42–1.50), Asian/Pacific Islanders (1.12, 1.09–1.15), and Latino whites (1.06, 1.04–1.08) compared to non-Latino whites, and was significantly higher for low socioeconomic status compared to high socioeconomic status (1.31, 1.29–1.34). Survival disparities by stage, race/ethnicity, and socioeconomic status worsened over time.

“For AYAs in aggregate, the historical cancer survival improvement gap has been closed. However, the growing survival disparities in AYA subsets reported here, including advanced stage disease, racial/ethnic minorities, and low socioeconomic status, highlight new priorities needing increased attention, including inequities in cancer care and delivery within this vulnerable population,” concluded the study authors.

Improving Survival Outcome for AYAs

“This [study result] highlights that continued research is required in this vulnerable age group,” said Diana J. Moke, MD, MS, Clinical Instructor of Pediatrics (Fellow) at the Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, and lead author of this study, in a statement. “This research is necessary to improve survival in certain cancer types that have not shown any recent progress, find novel therapies for advanced-stage disease in all cancer types, and ensure that survival improvements reach all young patients, regardless of race/ethnicity or socioeconomic status.”

Dr. Moke is the corresponding author of this study.

Disclosure: Funding for this study was provided by the National Institutes of Health. For full disclosures of the study authors, visit academic.oup.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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