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Site of care contributes to survival of adolescents and young adults with leukaemia

Adolescents and young adults (AYAs) with acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) who were not treated at specialised cancer centres had significantly worse five-year survival compared with children with these cancers who were treated at specialised cancer centres, whereas AYAs treated at specialised cancer centres had outcomes comparable to children treated at specialised cancer centres.

"A much smaller percentage of Adolescents and young adults (AYAs) with cancer are treated at specialised cancer centers than children with cancer," she added.

"We wanted to understand whether this difference in the site of cancer care is associated with the difference in survival outcomes."

Wolfson and colleagues used data from the Los Angeles County Cancer Surveillance Program to identify patients diagnosed with acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML) from ages 1 to 39.

Patients were considered to have been treated at a specialised cancer centre if at any age they were cared for at any of the National Cancer Institute-designated Comprehensive Cancer Centers in Los Angeles County or if at the age of 21 or younger they were cared for at any of the Children's Oncology Group sites not designated a Comprehensive Cancer Center.

Included in the analysis were 978 patients diagnosed with ALL as a child (ages 1 to 14), 402 patients diagnosed with ALL as an AYA (ages 15 to 39), 131 patients diagnosed with AML as a child, and 359 patients diagnosed with AML as an AYA.

Among these groups, 70 percent, 30 percent, 74 percent, and 22 percent were treated at a specialised cancer centre, respectively.

Five-year relative survival rates declined with age for both ALL and AML.

Wolfson explained that the researchers excluded data from children with ALL ages 1 to 9 in subsequent analysis because these patients have significantly improved survival compared with other groups, likely as a result of different disease biology.

They found that AYAs diagnosed at ages 15 to 21 and 22 to 29 who were treated at specialised cancer centres had comparable overall and leukaemia survival to children diagnosed with ALL from ages 10 to 14 and treated at a specialised cancer centre.

Using the same referent population, AYAs in these age groups who were not treated at specialised cancer centers had an approximately two-fold increased risk of death.

AYAs diagnosed at ages 30 to 39 had an approximately three-fold increased risk of death irrespective of where they received care.

For AML, AYAs diagnosed at ages 15 to 21 who were treated at specialised cancer centres had comparable overall and leukaemia survival to children diagnosed from ages 1 to 14 and treated at a specialised cancer centre.

AYAs diagnosed at ages 15 to 21 who were not treated at a specialised cancer centre had a 1.7-fold increased risk for death.

AYAs diagnosed at ages 22 to 39 had an approximately three-fold increased risk of death irrespective of where they received care.

Among AYAs ages 21 to 39, those who were uninsured or publicly insured had a more than 70 percent lower likelihood of being treated at a specialised cancer centre compared with those who had private health insurance.

"We found that AYAs diagnosed with ALL from age 15 to 29 or diagnosed with AML from age 15 to 21 who were treated at specialised cancer canters had better outcomes than their peers who were not treated at specialised cancer centres when each group was compared with children treated at specialised cancer centres," said Wolfson.

"These data suggest that treatment at a specialised cancer centre can mitigate the poor outcomes in younger AYAs compared with children. We were also able to identify some barriers to being treated at specialised cancer centers for AYAs, which we hope can be used to address the gap in provision of high-quality cancer care to a vulnerable population."

"The fact that the older AYAs did not appear to benefit from treatment at a specialised cancer centre suggests to us that the biology of the disease in these patients differs from that in younger individuals," continuedd Wolfson.

"The most important thing we can do to help these patients is to enroll them on clinical trials so that we can better understand the biology of the disease and its response to therapy."

According to Wolfson, the main limitation of the study is that the data were obtained from a cancer registry, which does not provide detailed information about each patient's treatment regimen or the features of their disease.

Source: American Association for Cancer Research

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