title: Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome.
abstract: Background:Adolescents and young adults (AYA; 15-39 years) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on survival disparities remains unstudied.Methods:Using the Los Angeles cancer registry, we identified 1,870 ALL or AML patients between 1 and 39 years at diagnosis. Cox regression analyses assessed risk of mortality; younger age + CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above.Results:ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21 years: HR = 1.9,P= 0.005; 22-29 years: HR = 2.6,P< 0.001; 30-39 years: HR = 3.0,P< 0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21 years: HR = 1.3,P= 0.3; 22-29 years: HR = 1.2,P= 0.2) but was inferior for 30- to 39-year-olds (HR = 3.4,P< 0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21 years: HR = 1.8,P= 0.02; 22-39 years: HR = 1.4,P= 0.06). Outcome at CCC/COG was comparable between children and 15- to 21-year-olds (HR = 1.3,P= 0.4) but was inferior for 22- to 39-year-olds (HR = 1.7,P= 0.05). Access: 15- to 21-year-olds were less likely to use CCC/COG than children (P< 0.001). In 22- to 39-year-olds, public/uninsured (ALL:P= 0.004; AML<0.001), African American/Hispanics (ALL:P= 0.03), and 30- to 39-year-olds (ALL:P= 0.03) were less likely to use CCC/COG.Conclusions:Poor survival in AYAs with ALL and AML is mitigated by care at CCC/COG. Barriers to CCC/COG care include public/uninsured, and African American/Hispanic race/ethnicity.Impact:Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers.Cancer Epidemiol Biomarkers Prev; 26(3); 312-20. ©2017 AACR.
authors.affiliation: Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. jwolfson@peds.uab.edu.|Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Wolfson
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.affiliation: Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Wyatt
authors.affiliation: Section of Hematology/Oncology, University of Chicago, Chicago, Illinois.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stock
authors.affiliation: Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Population Sciences, City of Hope, Duarte, California.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality*; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D055815:Young Adult