title: Impact of treatment site in adolescents and young adults with central nervous system tumors.
abstract: BACKGROUND
  Adolescents and young adults (AYAs; aged 15-39 years) have inferior survival in comparison with younger (aged 0-14 years) cancer patients. Impact of care at specialized centers such as National Cancer Institute-designated Comprehensive Cancer Centers (NCICCC) for AYAs of all ages or the Children's Oncology Group (COG) for AYAs aged 15 to 21 years with central nervous system (CNS) tumors remains unstudied.
  
  
  METHODS
  We constructed a cohort of 560 children and 784 AYAs with CNS tumors reported to the Los Angeles cancer registry from 1998 to 2008. Cox and logistic regression models were used, with two-sided P values from Wald χ(2) tests.
  
  
  RESULTS
  In Cox regression analysis restricted to World Health Organization (WHO) grade II tumors, patients of all ages saw worse outcome if not treated at NCICCC/COG sites (non-NCICCC/COG vs NCICCC/COG: hazard ratio [HR] =1.73; 95% confidence interval [CI] = 1.09 to 2.72). Furthermore, the worse outcome for AYAs compared with children (HR = 1.90; 95% CI = 1.21 to 2.98; P = .005) was abrogated (HR = 1.35; 95% CI = 0.79 to 2.29; P = .27) by care at NCICCC/COGs. Those less likely to receive care at NCICCC/COG sites included young AYAs (aged 15-21 years vs children: odds ratio [OR] = 0.23; 95% CI = 0.11 to 0.48; P < .001) and older AYAs (aged 22-39 years) with low socioeconomic status (OR = 0.39; 95% CI = 0.17 to 0.89; P = .02), public/no insurance (OR = 0.30; 95% CI = 0.12 to 0.71; P < .01), and distance to care greater than 5 miles (OR = 0.29; 95% CI = 0.15 to 0.57; P < .001).
  
  
  CONCLUSIONS
  Population-based data reveal that care at NCICCC/COG sites mitigates inferior outcome in AYAs with WHO grade II CNS tumors compared with children. Compared with children, AYAs are less likely to receive care at NCICCC/COGs. Insurance, socioeconomic status, and distance serve as barriers to care at NCICCCs for older AYAs.
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA.
authors.forename: Julie
authors.initials: J
authors.lastname: Wolfson
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA.
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA.
authors.forename: Tongjun
authors.initials: T
authors.lastname: Kang
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA.
authors.forename: Laura
authors.initials: L
authors.lastname: Wyatt
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA.
authors.forename: Massimo
authors.initials: M
authors.lastname: D'Appuzzo
authors.affiliation: Department of Population Sciences (JW, C-LS, TK, LW, SB) and Department of Pathology (MD), City of Hope, Duarte, CA. sbhatia@coh.org.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002173:Cancer Care Facilities; D016543:Central Nervous System Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D060787:Neoplasm Grading; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012923:Social Class; D016019:Survival Analysis; D055815:Young Adult