Where Adolescents and Young Adults With Cancer Receive Their Care: Does It Matter?

Abstract

During the last 25 years, improvement in survival for young children with cancer has been striking. Survival has also increased for older adults; however, 5-year survival rates have fallen for older adolescent and young adult (AYA) cancer patients. 1 Reasons for this decline, termed the “AYA Cancer Survival Gap,” remain unknown. Bleyer et al 2 suggested that a lower participation rate on clinical trials in this age group may partially account for poorer survival, but the reasons why remain unclear. The type of practice where cancer care is delivered may also influence clinical trial participation and outcome. Two articles in this issue of the Journal of Clinical Oncology analyzed where older adolescents and young adults received their cancer care. 3,4 Both utilized statewide, population-based cancer registries to describe the referral patterns for older AYAs with cancer. Newly diagnosed AYAs with cancer were categorized by whether or not they received their care at institutions that participate in the Children’s Oncology Group (COG). Albritton et al 3 identified characteristics predictive of receiving care at a pediatric oncology versus medical oncology treatment program. Whether care was delivered at Utah’s only pediatric cancer treatment program, the Primary Children’s Medical Center (PCMC; Salt Lake City), was determined for all incident cancer cases aged 0 to 24 years from the Utah Cancer Registry. Overall, 34% of older adolescents aged 15 to 19 years were seen at PCMC, whereas 97% of children age 0 to 9 years and 82% of children 10 to 14 years were seen at PCMC. The rate at which older adolescents were cared for at a pediatric center varied by diagnosis: 29% for lymphoma, 34% for brain tumors, and 53% for leukemias. Howell et al 4 found that 87% of young patients 0 to 14 years in Georgia were seen at one of the five COG-affiliated institutions in the state. Compared with younger patients, only 36% of 15- to 19-year-olds were seen at COG institutions. In an earlier analysis of Surveillance, Epidemiology, and End Results (SEER) cases from