title: Cancer mortality among adolescents and young adults: A historical cohort in a reference institution for cancer treatment in Santa Catarina/South of Brazil 2002-2013.
abstract: OBJECTIVE
  To identify factors associated with early mortality from cancer in adolescents and young adults in a reference institution for oncology treatment in Santa Catarina, Brazil.
  
  
  METHODS
  We studied a retrospective cohort with an intentional sample of adolescents (ages 15-19) and young adults (ages 20-29) diagnosed with neoplasia. Secondary data were acquired from January 2002 to December 2013. Kaplan-Meier and Cox regression methods were used for survival analysis. Logistical analysis tested the association between early death (lower tertile between diagnosis and death, according to cancer type) and clinical or sociodemographic variables.
  
  
  RESULTS
  We included a total of 889 cases with an average age of 23, with similar gender distributions and a predominance of Caucasian ethnicity. Using the Cox framework of proportional risks adjusted for neoplasia types and gender, individuals with non-hematological neoplasia (solid tumors) presented a 47% higher risk of dying when compared with individuals diagnosed with leukemias and lymphomas (HR: 1.47; 95%CI: 1.12-1.93). Chances of death were 31% higher for males than for females (HR: 1.31; 95%CI: 1.02-1.69). When adjusting for type of neoplasia and age (15-24 and 25-29) the risk of death by cancer was 51% greater in individuals diagnosed with non-hematological neoplasia when compared with individuals diagnosed with leukemias and lymphomas (HR: 1.51; 95%CI: 1.15-1.99). The chance of death by cancer in patients under the age of 25 was 33% greater when compared to that in older patients between the ages of 25 and 29 (HR: 1.33; 95%CI: 1.04-1.75). In multiple regression analysis, factors associated with early mortality from cancer were the number of years in school (P=0.011) and time between diagnosis and start of treatment (P<0.001).
  
  
  CONCLUSIONS
  The sample studied with a longer period of time between diagnosis and the start of treatment (access to oncology therapy) and with fewer years in school showed that these factors had important roles in early death from cancer for the observed individuals. This must be considered when planning and identifying risk in young cancer patients in order to lower the impact of the disease on mortality for this age group.
authors.affiliation: Department of Cancer Epidemiology-Oncological Research Center of Santa Catarina (CEPON/SC), Brazil. Electronic address: lizana.arend@fastmail.net.
authors.forename: Lizana Arend
authors.initials: LA
authors.lastname: Henrique
authors.affiliation: Department of Public Health-Post-graduation Program, Federal University of Santa Catarina (UFSC), Brazil.
authors.forename: Isabela
authors.initials: I
authors.lastname: de Carlos Back
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Adolescent; Cancer; Mortality; Survival; Young adult