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Survival rates stagnate among adolescents, young adults with cancer
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Survival rates among adolescents and young adults with cancer have failed to keep pace with improvements observed in other age groups, according to study results.
Amie Hwang, PhD, assistant professor of clinical preventive medicine at Keck School of Medicine of USC, and colleagues conducted a comprehensive analysis of patients with cancer in Los Angeles County. They focused on the adolescent and young adult (AYA) population, defined at those aged 15 to 39 years.
The analysis included data from 1988 to 2014. The individuals had one of 19 malignancies, and they represented a cross-section of ethnic and socioeconomic backgrounds.
Results showed varying degrees of effectiveness of cancer treatment in different subgroups, as well as poor survival rates among men and black patients.
HemOnc Today spoke with Hwang about the study results, the importance of focusing more attention on outcomes in the AYA population, and strategies to improve survival in this subgroup.
Question: Why are outcomes for AYAs with cancer poorly understood ?
Answer: In the last few decades, a lot of time and resources in cancer research have gone to helping pediatric populations and older populations. Until recently, survival rates among children were very poor, and research has changed that. A similar trend has occurred for patients aged older than 40 years. During the time when all of these efforts were being made, AYA patients suffered middle child syndrome. The group of patients aged 15 to 39 were left behind in terms of cancer research. They haven’t seen the kinds of improvements in survival that the other age groups have seen. In the early 2000s, researchers realized this was happening. The NCI and the Livestrong Foundation came together to address this. That is when the term “AYA” was coined. Since then, there have been more efforts to improve the health outcomes for this age group. We are starting to see improvements, but we still have not caught up.
Q : How did your analysis come about?
A : In the past decade, researchers — including my group — have tried to study the reason for the poor outcomes among AYAs. The Cancer Surveillance Program is the legal agent of the California Cancer Registry for Los Angeles County. We have tracked every diagnosed cancer case in the county since 1972 as part of our routine surveillance activity. We use those data to find trends and disparities in cancer. When the AYA phenomenon came to light, we wanted to address this issue at a population level. Los Angeles County is one of the largest and most diverse counties in the United States, with around 10 million people. These characteristics allow us to look at how cancer affects different groups: How the cancer burden differs among racial and ethnic groups, patients of different age groups, and those with varying degrees of socioeconomic status. In this report, we describe how cancer survival rates vary among young people and address it in terms of sociodemographic factors.
Q : Can you describe what you found in terms of socioeconomics and ethnicity?
A: We looked at the 19 most common cancers that occur in the AYA age group. One surprising result was seeing the same social gradient we see among older adults. When people get cancer at a young age, it’s mostly assumed to be driven by genetics, not behavior. We found the likelihood of surviving these cancers varies by sociodemographic gradients in this young population, too. African-Americans have poor survival compared with other groups. Individuals with low socioeconomic status also have low survival compared with other groups. Men tend to do more poorly than women. Some of this disparity is due to biological differences, but some degree of socioeconomic and demographic factors speaks to lifestyle and health care-seeking behavior. We saw that these factors affect the AYA group, as well. Men tend to not seek routine medical care and only go to the doctor when they are sick. Those who don’t go to doctors have a delay in diagnosis, which leads to a later-stage diagnosis. Later-stage cancer is harder to treat. A similar phenomenon occurs among patients with low socioeconomic status. They have limited options for care and limited resources. They experience a delay in diagnosis, which leads to poor outcomes.
Q : What are the next steps?
A: In this report, there is an incredible amount of data. How do survival rates differ by patient characteristics? How do they contrast across each of these 19 cancers? The report is put together for clinicians and researchers to identify areas of need — the high-risk populations we really need to focus on. We hope that other experts can access it and make use of the data. We also hope that patients and their families can use it to find answers about their cancer prognosis.
Q : Is there anything else you would like to add?
A : The number one prognostic factor is stage at diagnosis. We don’t go into detail about treatments or other interventions for these cancers, but this document provides a clear trend that shows many of these patients do not get a timely diagnosis. We hope that other researchers will begin to understand this problem more clearly and will place their research and clinical efforts to avoid delay in diagnosis. – by Rob Volansky
Reference:
Liu L, et al. Cancer in Los Angeles County: Survival among adolescents and young adults 1988-2014. Available at: keck.usc.edu/cancer-surveillance-program/wp-content/uploads/sites/166/2016/03/aya_survival_2017.pdf. Accessed on Feb. 14, 2018.
For more information:
Amie Hwang, PhD, can be reached at Department of Preventive Medicine, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, 1441 Eastlake Ave., MC 9175, Los Angeles, CA 90032; email: amie.hwang@med.usc.edu.
Disclosure: Hwang reports no relevant financial disclosures.