title: Adolescents with acute lymphoblastic leukemia treated at pediatric versus adult hospitals.
abstract: BACKGROUND
  The objective was to compare 5-year overall survival (OS) between adolescent and young adult (AYA) patients (age 15-19) with acute lymphoblastic leukemia (ALL) treated at a pediatric versus an adult center.
  
  
  METHODS
  This was a population-based analysis using administrative data of Ontario ALL AYA patients diagnosed between 1986-2009. We calculated predicted survival proportions (PSPs) and 95% confidence intervals (CI). We also surveyed sites to determine whether pediatric or adult-based protocols were used in each period.
  
  
  RESULTS
  Overall, 290 patients between 15-19 years of age were diagnosed with ALL during the study period; 144 patients (49.7%) were treated at an adult center. When adjusted for gender, age, income quintile and time period, AYA patients treated at a pediatric center did not have a significantly different PSP (0.65, 95% CI: 0.56-0.75) in comparison to those treated at an adult center (0.62, 95% CI 0.52-0.73; P = 0.87). Most AYA patients treated at adult centers received pediatric protocols in the recent periods.
  
  
  CONCLUSIONS
  Using population-based data, AYA ALL patients had similar outcomes whether treated at a pediatric or an adult center. Early introduction of aggressive treatment protocols in adult centers may have negated differences in outcomes among AYA patients by site of care.
authors.affiliation: Pediatric Oncology Group of Ontario, Toronto, Canada.
authors.forename: J D
authors.initials: JD
authors.lastname: Pole
authors.forename: S M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: M C
authors.initials: MC
authors.lastname: Ethier
authors.forename: O
authors.initials: O
authors.lastname: Teuffel
authors.forename: C
authors.initials: C
authors.lastname: Portwine
authors.forename: S
authors.initials: S
authors.lastname: Zelcer
authors.forename: D L
authors.initials: DL
authors.lastname: Johnston
authors.forename: M
authors.initials: M
authors.lastname: Silva
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: J M
authors.initials: JM
authors.lastname: Brandwein
authors.forename: L
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D002173:Cancer Care Facilities; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009864:Ontario / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D055815:Young Adult