Radiation Therapy Utilization in Adolescent and Young Adult Oncology Patients

Abstract

Purpose/Objective(s): In 2006, the Surveillance, Epidemiology, and End Results (SEER) adolescent and young adult (AYA) monograph was released and provided detailed information about cancer incidence and survival in the AYA patients 15-29 years of age. This monograph illustrated that AYA patients have had a lack of progress in survival relative to other age groups. While the incidence of cancer is steadily increasing in this population, the survival deficit means that AYA patients diagnosed with cancer today have a relatively worse prognosis than 25 years ago. No treatment information was provided in the SEER monograph. This study aims to look at utilization of radiation therapy (RT) in 15-29 year olds and compare it to the pediatric population as well as those older than 30 years of age for the common cancers that appear within this age group. Materials/Methods: The SEER database, was queried to determine RT utilization in patients 15-29. We selected a cohort of all patients diagnosed with one of the common AYA cancers between 1975 and 2010. We excluded patients with a second cancer diagnosis, with metastases at diagnosis, without confirmation of disease, and those who did not have follow-up. Results: We analyzed RT utilization in over 3.6 million cancer patients from 1975-2010; this included 37,673 patients less than 15 years of age, 129,356 15-29 years of age and 3,434,120 that were 30 years of age or older. We found that RT was used in 22.6% of pediatric patients, 14.9% of AYA patients and 22.7% of adult patients with non-metastatic disease. RT utilization in the AYA population was lower than in the pediatric or adult population from 1975-2010. AYA patients were 53% less likely than pediatric patients (OR 0.469, 95% CI 0.45-0.48) to receive RT. The odds of an adult patient receiving radiation were 1.48 times more than an AYA patient (OR 1.48, 95% CI 1.46 to 1.506). Amongst all patients, female sex, regional disease and non-Hispanic black race were predictors of RT use on multivariate analysis (p<0.001 for all). Hispanic patients had a 21% decreased odds of receiving radiation (OR 0.79, 95%CI 0.786-0.8). Conclusions: RT utilization in the AYA population was proportionally less than in either the pediatric or adult population. RT utilization in the AYA oncology population requires further investigation based on the unique medical and psychosocial needs of this group. Author Disclosure: L.K. Ballas: None. J. Huo: None. B. Guadagnolo: None.