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Race/ethnicity, socioeconomic status associated with increased risk for death among young cancer survivors
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Non-Latino white adolescents and young adults who are cancer survivors have a lower risk for subsequent death compared with survivors of other races and ethnicities, according to research published in JNCI Cancer Spectrum.
Researchers observed this disparity despite an overall improvement in 5-year survival rates among all adolescents and young adults (AYAs), led by reduced mortality among patients with HIV- and AIDS-related cancers.
Diana J. Moke , MD, assistant professor of pediatrics in the Children’s Center for Cancer and Blood Diseases at Children's Hospital Los Angeles, said her group initiated the research to provide a current snapshot of cancer survival among AYAs aged 15 to 39 years.
“It has been over 10 years since the landmark comprehensive assessment of adolescent and young adult cancer survival,” she told HemOnc Today, referring to the NCI Progress Review Group’s “Closing the Gap” report, which showed a lack of improvement in cancer survival among AYAs vs. other age groups from 1977 to 1997. “During that time, there have been many research and health initiatives aimed at improving survival in adolescents and young adults.”
Moke and colleagues evaluated changes in survival among AYAs compared with younger and older cancer survivors using the California Cancer Registry, which tracks patient data on all cancer diagnoses within the state. The investigators collected data on all AYAs diagnosed with first primary invasive cancer, benign cancer in the brain or central nervous system, or bladder cancer in situ from 1988 to 2014.
They compared data from the AYA group (aged 15 to 39 years) with data from younger children (aged 0 to 14 years) and older adults (aged 40 years).
The study separately examined two time periods, 1988 to 2000 and 2001 to 2014, to provide a reference point for comparative analysis.
“This demarcation was selected as a chronological midpoint in our follow-up period that roughly corresponds to emergence of an era with growing emphasis on AYA disparities by the NCI, the Children’s Oncology Group and certain adult cooperative oncology groups in the U.S., as well as advocacy organizations,” Moke and colleagues wrote.
The study population — including those diagnosed between 1988 and 2000 (n = 107,747) and 2001 and 2014 (n = 117,746) — was largely comprised of patients with localized disease (46.5% and 51.6%), women (53.1% and 59.3%), those aged 35 to 39 years (41.2% and 39.1%) and non-Latino white individuals (59.5% and 45.9%).
Socioeconomic status was evenly distributed among the groups during both time periods.
The AYA group demonstrated significantly lower risk for death in the 2001-to-2014 time period compared with 1988 to 2000. Crude HRs among AYA age groups ranged from 0.66 for ages 35 to 39 years to 0.83 for ages 15 to 19 years.
Moke said her research team was surprised by the robust improvement in aggregate AYA survival results.
“While we were hopeful to see such a trend, we were expecting to continue to see lagging survival improvements among AYAs, as were noted previously,” she said.
The inclusion of HIV/AIDS-related Kaposi sarcoma in the analysis dramatically increased survival in the AYA age group. For example, 5-year survival increased by 20.6% in men and 4.2% in women aged 30 to 34 years with Kaposi sarcoma in the analysis.
“The dramatic improvement in survival among those with HIV/AIDS-related cancers was due to the introduction of effective antiretroviral therapy in the late 1990s,” Moke told HemOnc Today. “With this introduction, both the incidence of such cancers, and the mortality from these cancers, has significantly decreased.”
In the adjusted analyses, the strongest predictor of death among AYAs was cancer stage (distant vs. localized adjusted HR [aHR] = 6.32; 95% CI, 6.2-6.45).
Black AYAs had a significantly higher risk for death than non-Latino white AYAs (aHR = 1.46; 95% CI, 1.42-1.5). The same was true for Asian/Pacific Islanders (aHR = 1.12; 95% CI, 1.09-1.15) and Latino whites (aHR = 1.06; 95% CI, 1.04-1.08) compared with non-Latino whites.
AYAs with lower socioeconomic status also had a significantly higher risk for death compared with AYAs with high socioeconomic status (aHR = 1.31; 95% CI, 1.29-1.34).
Moke and colleagues noted the widening survival disparities according to cancer stage, race/ethnicity and socioeconomic status.
“Even though these results are promising and pay tribute to the recent efforts dedicated to AYAs, we also found that not all AYA patients have shown equal improvements ... and in some cases, these survival disparities are worsening over time,” Moke told HemOnc Today.
“The results of this study highlight that certain AYA cancers and certain subgroups of AYAs are still at higher risk of dying of their cancer,” Moke added. “Further research efforts are needed to identify how to translate these findings into interventions to help improve survival for all patients in this vulnerable age group and to ensure that survival improvements reach all young patients, regardless of race/ethnicity or socioeconomic status.” – by Drew Amorosi
For more information:
Diana Moke , MD, can be reached at Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #54, Los Angeles, CA 90027; email: dmoke@chla.usc.edu.
Disclosures: The authors report no relevant financial disclosures.
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