Sites of care may help explain survival differences between children and adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), according to research published in Cancer Epidemiology, Biomarkers & Prevention (published online February 16, 2017; doi:10.1158/1055-9965.EPI-16-0722).
AYAs aged 15 to 39 years with AML or ALL experience inferior survival when compared with children aged 14 and younger. A much smaller percentage of AYAs with acute leukemia are treated at specialized cancer centers, such as National Cancer Institute (NCI)-designated Comprehensive Cancer Centers or Children’s Oncology Group sites, than children with such diseases. The impact of care on survival disparities at these specialized cancer centers remains to be studied.
Julie Wolfson, MD, MSHS, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, and colleagues conducted a study to explore a potential association between survival disparities among children and AYAs and site of care. Researchers collected data from the Los Angeles County Cancer Surveillance Program to identify 978 patients with ALL as a child, 402 patients with ALL as an AYA, 131 patients with AML as a child, and 359 patients with AML as an AYA.
Patients were considered to have been treated at a specialized cancer center if they were cared for at any NCI-designated Comprehensive Cancer Centers in Los Angeles County at any age or if they were cared for at a Children’s Oncology Group site not designated a Comprehensive Cancer Center at age 21 or younger. Among the groups, 70% of patients with ALL as a child, 30% of patients with ALL as an AYA, 74% of patients with AML as a child, and 22% of patients with AML as an AYA were treated at a specialized cancer center.
Results of the study showed that adolescents with ALL who were not treated at specialized cancer centers experienced inferior survival (15-21 years: hazard ratio [HR] = 1.9, P = .005; 22-29 years: HR = 2.6, P < .001; 30-39 years: HR = 3.0, P < .001). Survival outcomes at specialized cancer centers were comparable between children and AYAs (15-21 years: HR = 1.3, P = .3; 22-29 years: HR = 1.2, P = .2) but were inferior for patients aged 30 to 39 years with ALL (HR = 3.4, P < .001). Similar results were observed for children as well as AYAs with AML.
Researchers concluded that treatment at a specialized cancer center can mitigate poor outcomes in younger AYAs compared with children.
Researchers noted that some barriers to being treated at specialized cancer centers exist, including insurance coverage and ethnicity. These barriers may be used to address the gap in provision of high-quality cancer care to AYAs.—Zachary Bessette
