title: Cancer survival and excess mortality estimates among adolescents and young adults in Western Australia, 1982-2004: a population-based study.
abstract: BACKGROUND
  Data are limited on cancer outcomes in adolescents and young adults.
  
  
  METHODS
  Based on data from the Western Australian Data Linkage System, this study modelled survival and excess mortality in all adolescents and young adults aged 15-39 years in Western Australia who had a diagnosis of cancer in the period 1982-2004. Relative survival and excess all-cause mortality for all cancers combined and for principal tumour subgroups were estimated, using the Ederer II method and generalised linear Poisson modelling, respectively.
  
  
  RESULTS
  A cancer diagnosis in adolescents and young adults conferred substantial survival decrement. However, overall outcomes improved over calendar period (excess mortality hazard ratio [HR], latest versus earliest diagnostic period: 0.52, trend p<0.0001). Case fatality varied according to age group (HR, oldest versus youngest: 1.38, trend p<0.0001), sex (HR, female versus male: 0.66, 95% confidence interval [CI] 0.62-0.71), ethnicity (HR, Aboriginal versus others: 1.47, CI 1.23-1.76), geographical area (HR, rural/remote versus urban: 1.13, CI 1.04-1.23) and residential socioeconomic status (HR, lowest versus highest quartile: 1.14, trend p<0.05). Tumour subgroups differed substantially in frequency according to age group and sex, and were critical outcome determinants.
  
  
  CONCLUSIONS
  Marked progressive calendar-time improvement in overall outcomes was evident. Further research is required to disentangle the contributions of tumour biology and health service factors to outcome disparities between ethno-demographic, geographic and socioeconomic subgroups of adolescents and young adults with cancer.
authors: School of Population Health, Centre for Health Services Research, The University of Western Australia, Crawley, Australia. fhaggar@toh.on.ca
authors: Fatima A
authors: FA
authors: Haggar
authors: Gavin
authors: G
authors: Pereira
authors: David D
authors: DD
authors: Preen
authors: C D'Arcy J
authors: CD
authors: Holman
authors: Kristjana
authors: K
authors: Einarsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult