When and Why Do Teenage and Young Adult Oncology Patients Die Early in the Cancer Pathway?

Abstract

ABSTRACT Aim: Teenage and young adult (TYA) oncology patients fall between adult and paediatric services. Recent data has revealed early deaths in TYAs. Amongst adults, early deaths are a proxy measure for late stage presentation or treatment delay, whereas amongst children early deaths are often treatment-related. In TYA patients the cause of early deaths remains unknown. We aim to examine early deaths and whether they are related to anti-cancer therapy. Methods: We analysed population based Northern and Yorkshire Cancer Registry and Information Service data of all patients aged 13-24 years inclusive at cancer diagnosis (n = 1137), over 12 years to 31/12/2011. We used morphological classification, descriptive statistics, cox regression models and death certificate review to examine patterns and causes of death, within one year of diagnosis. Results: Of 1137 TYAs, 95 died within 12 months of diagnosis (45% of all deaths). Most of these deaths were between 90 and 365 days. Only patients with leukaemias, non-Hodgkin's lymphoma, central nervous system tumours and soft tissue sarcomas (STS) died within 30 days. Highest risk of mortality within one year was in acute lymphoblastic leukaemia (HR 1.86, p = 0.039), STS (HR 2.38, p = 0.004) and gastric carcinoma (HR 10.86, p Conclusions: The highest incidence of deaths in TYA cancer patients is in the first year after diagnosis. One year mortality varies according to cancer diagnosis. Very few deaths are attributed to anti-cancer therapy. Reducing one year death rate, in STS and AML particularly, may contribute to improving survival in TYA cancer patients. Disclosure: All authors have declared no conflicts of interest.