title: Use of appropriate initial treatment among adolescents and young adults with cancer.
abstract: BACKGROUND
  There has been little improvement in the survival of adolescent and young adult (AYA) cancer patients aged 15 to 39 years relative to other age groups, raising the question of whether such patients receive appropriate initial treatment.
  
  
  METHODS
  We examined receipt of initial cancer treatment for a population-based sample of 504 AYAs diagnosed in 2007-2008 with acute lymphoblastic leukemia (ALL), Hodgkin's or non-Hodgkin's lymphoma, germ cell cancer, or sarcoma. Registry data, patient surveys, and detailed medical record reviews were used to evaluate the association of patient demographic, socioeconomic, and health care setting characteristics with receipt of appropriate initial treatment, which was defined by clinical specialists in AYA oncology based on adult guidelines and published literature available before 2009 and analyzed with multivariable logistic regression. All statistical tests were two-sided.
  
  
  RESULTS
  Approximately 75% of AYA cancer patients in our sample received appropriate treatment, 68% after excluding stage I male germ cell patients who all received appropriate treatment. After this exclusion, appropriate treatment ranged from 79% of sarcoma patients to 56% of ALL patients. Cancer type (P < .01) and clinical trial participation (P = .04) were statistically significantly associated with appropriate treatment in multivariable analyses. Patients enrolled in clinical trials were more likely to receive appropriate therapy relative to those not enrolled (78% vs 67%, adjusted odds ratio = 2.6, 95% confidence interval = 1.1 to 6.4).
  
  
  CONCLUSIONS
  Except for those with early stage male germ cell tumors, approximately 30% (or 3 in 10) AYA cancer patients did not receive appropriate therapy. Further investigation is required to understand the reasons for this potential shortfall in care delivery.
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW). alp49@georgetown.edu.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Karen
authors.initials: K
authors.lastname: Albritton
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kato
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Gretchen
authors.initials: G
authors.lastname: Keel
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Michele M
authors.initials: MM
authors.lastname: West
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (LCH); Cook Children's Medical Center and University of North Texas Health Science Center Fort Worth, TX (KA); Public Health Institute/Cancer Registry of Greater California, Sacramento, CA (RDC); Monroe Carell Jr. Children's Hospital, Vanderbilt-Ingram Cancer Center, Nashville, TN (DLF); Keck School of Medicine, University of Southern California, Los Angeles, CA (ASH); Departments of Oncology and Pathology, Wayne State University, Detroit, MI (IK); Cancer Prevention Institute of California, Fremont, CA (THMK); School of Medicine, Stanford University, Stanford, CA (THMK); Information Management Services, Inc., Silver Spring, MD (GK); Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SMS); Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD (NLS); Department of Urology, Division of Pediatric Urology, University of Washington, Seattle Children's Hospital, Seattle, WA (MS); Department of Epidemiology, University of Iowa, Iowa City, IA (MMW); Louisiana State University, New Orleans, LA (XCW).
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D018237:Germinoma / Q000628:therapy; D006689:Hodgkin Disease / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011787:Quality of Health Care / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D018426:SEER Program; D012509:Sarcoma / Q000628:therapy; D014481:United States; D055815:Young Adult