Abstract
BackgroundRetrospective studies have shown adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) have superior survival when treated in pediatric versus adult centers (locus of care; LOC). Several adult centers recently adopted pediatric protocols. Whether this has narrowed LOC disparities in real–world settings is unknown.MethodsThe IMPACT Cohort is an Ontario population–based cohort that captured demographic, disease and treatment (treatment protocol, chemotherapy doses) data for all 15‐21 year olds diagnosed with ALL 1992‐2011. Cancer outcomes were determined by chart abstraction and linkage to provincial healthcare databases. Treatment protocols were classified as pediatric‐ or adult‐based. We examined predictors of outcome, including LOC, protocol, disease biology, and time period.ResultsOf 271 patients, 152 (56%) received therapy at adult centers. 5‐year event‐free survival (EFS ± SE) among AYA at pediatric vs adult centers was 72% ± 4% vs 56% ± 4% (P = 0.03); 5‐year overall survival (OS) was 82% ± 4% vs 64% ± 4% (P < 0.001). After adjustment, OS remained inferior at adult centers (hazard ratio 2.5; 95% confidence interval 1.1‐6.1; P = 0.04). In the most recent period (2006‐2011), 39/59 (66%) AYA treated at adult centers received pediatric protocols. These AYA had outcomes superior to the 20 AYA treated on adult protocols, but inferior to the 44 AYA treated at pediatric centers (EFS 72% ± 5% vs 60% ± 9% vs 81% ± 6%; P = 0.02; OS 77% ± 7% vs 65% ± 11% vs 91% ± 4%; P = 0.004). Induction deaths and treatment–related mortality did not vary by LOC.ConclusionsSurvival disparities between AYA with ALL treated in pediatric vs adult centers have persisted over time, partially attributable to incomplete adoption of pediatric protocols by adult centers. Although pediatric protocol use has improved survival, residual disparities remain, perhaps due to other differences in care between adult and pediatric centers.
Highlights
Adolescents and young adults (AYA) with cancer are a vulnerable group whose epidemiology differs from that of older adults and children.[1]
Using a population–based cohort of AYA in Ontario, Canada, we examined whether adult–based protocols had been widely adopted, and studied AYA acute lymphoblastic leukemia (ALL) outcomes by locus of care (LOC ‐ pediatric vs adult center) and type of protocol
In this population–based study combining clinical and health services data, we found that LOC–based disparities in the survival of AYA with ALL treated at pediatric compared to adult centers have persisted over time despite an overall improvement in outcome
Summary
Adolescents and young adults (AYA) with cancer are a vulnerable group whose epidemiology differs from that of older adults and children.[1]. Subsequent prospective studies examined the feasibility of providing pediatric–based treatment protocols to AYA regardless of where they receive their cancer care These studies confirmed the superiority of pediatric protocols as compared to historical controls, leading to calls for them to become standard for AYA.[5,6,7] several adult institutions have switched to using pediatric–based protocols for this population. It is unclear whether the adoption of pediatric–based protocols in adult centers has abolished disparities in AYA ALL outcomes between pediatric and adult centers and improved outcomes at a population‐level for this group of patients. We aimed to determine whether any persistent disparities were due to factors previously suggested in the literature, including incomplete adoption of pediatric–based protocols
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
