title: Clinical trial participation and time to treatment among adolescents and young adults with cancer: does age at diagnosis or insurance make a difference?
abstract: OBJECTIVE
  Because adolescent and young adult (AYA) patients with cancer have experienced variable improvement in survival over the past two decades, enhancing the quality and timeliness of cancer care in this population has emerged as a priority area. To identify current trends in AYA care, we examined patterns of clinical trial participation, time to treatment, and provider characteristics in a population-based sample of AYA patients with cancer.
  
  
  METHODS
  Using the National Cancer Institute Patterns of Care Study, we used multivariate logistic regression to evaluate demographic and provider characteristics associated with clinical trial enrollment and time to treatment among 1,358 AYA patients with cancer (age 15 to 39 years) identified through the Surveillance, Epidemiology, and End Results Program.
  
  
  RESULTS
  In our study, 14% of patients age 15 to 39 years had enrolled onto a clinical trial; participation varied by type of cancer, with the highest participation in those diagnosed with acute lymphoblastic leukemia (37%) and sarcoma (32%). Multivariate analyses demonstrated that uninsured, older patients and those treated by nonpediatric oncologists were less likely to enroll onto clinical trials. Median time from pathologic confirmation to first treatment was 3 days, but this varied by race/ethnicity and cancer site. In multivariate analyses, advanced cancer stage and outpatient treatment alone were associated with longer time from pathologic confirmation to treatment.
  
  
  CONCLUSIONS
  Our study identified factors associated with low clinical trial participation in AYA patients with cancer. These findings support the continued need to improve access to clinical trials and innovative treatments for this population, which may ultimately translate into improved survival.
authors.affiliation: Applied Research Program, National Cancer Institute, Bethesda, MD 20892-7344, USA. helen.parsons@nih.gov
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Stevens
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D018579:Patient Selection; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology / Q000628:therapy; D035842:Research Subjects; D018426:SEER Program; D012509:Sarcoma / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult