title: Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study.
abstract: OBJECTIVE
  Physicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited.
  
  
  METHODS
  Using the National Cancer Institute's population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests.
  
  
  RESULTS
  Treating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01).
  
  
  CONCLUSIONS
  Most AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.affiliation: Applied Research Program, National Cancer Institute , Bethesda, Maryland.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schmidt
authors.affiliation: The Cancer Prevention Institute of California , Fremont, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Department of Epidemiology, University of Iowa , Iowa City, Iowa.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Applied Research Program, National Cancer Institute , Bethesda, Maryland.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Kent
authors.affiliation: Louisiana Tumor Registry, Louisiana State University Health Sciences Center , New Orleans, Louisiana.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center , Seattle, Washington.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.affiliation: Department of Pediatrics, Wayne State University , Detroit, Michigan.
authors.forename: Roland L
authors.initials: RL
authors.lastname: Chu
authors.affiliation: Information Management Services , Calverton, Maryland.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Keel
authors.affiliation: Applied Research Program, National Cancer Institute , Bethesda, Maryland.
authors.forename: Ashley Wilder
authors.initials: AW
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D054547:National Cancer Institute (U.S.); D009369:Neoplasms / Q000628:therapy*; D017741:Survivors; D014481:United States; D055815:Young Adult
keywords: AYA HOPE Study; physicians; place of care; treatment