AACR report highlights dramatic improvement in outcomes for children, adolescents
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Key takeaways:
- Cancer death rates for children and adolescents declined sharply in the past 2 decades.
- Excessive alcohol use and stagnant HPV vaccination rates must be addressed to further improve cancer outcomes in the U.S.
The development of more effective treatments — including personalized therapies — have dramatically improved outcomes for children and adolescents with cancer, according to American Association for Cancer Research’s Cancer Progress Report.
The cancer death rate for both groups declined sharply in the past 2 decades, and more than eight in 10 children and adolescents diagnosed with cancer in the United States now survive at least 5 years after diagnosis, the report showed.
The 14th annual report also highlighted significant FDA approvals in the past year for the treatment of multiple cancer types, as well as key challenges — including the impact of alcohol consumption on cancer incidence, the financial burdens of cancer care and increasing numbers of certain HPV-associated malignancies — that must be overcome to ensure further improvement in cancer outcomes in the United States.
“The day is coming when every patient is holistically evaluated and your therapy is going to be very personalized to make sure that you have the best possible response of your tumor, but also have the best possible outcomes,” John L. Cleveland, PhD, executive vice president, center director and chief scientific officer at Moffitt Cancer Center, said during a presentation of the AACR report.
Childhood, AYA outcomes
Five-year survival rates for children with cancer have improved from 58% for those diagnosed in the mid-1970s to 85% for those diagnosed between 2012 and 2019, according to the report. The overall cancer death rate among children fell 70% between 1970 and 2021.
A similar trend has occurred among adolescents, defined as those aged 15 to 19 years. In this group, 5-year survival improved from 68% for those diagnosed in the mid-1970s to 86% for those diagnosed between 2012 and 2019. The overall cancer death rate in this age group declined 63% between 1970 and 2021.
Overall cancer mortality decreased 24% for children and adolescents during the past 20 years.
However, disparities persist. For example, cancer death rates declined by 12% among white children and adolescents between 2011 and 2021, but the death rate did not change significantly among Black or Hispanic children and adolescents during that same period.
Additionally, adult survivors of childhood cancers have faced financial hardships,
Although survival has improved for people diagnosed with cancer at young ages, adult survivors of childhood cancers often face considerable financial hardship.
The report showed 20.7% have had difficulties paying medical bills, 29.9% were sent to debt collection for unpaid bills and 14.1% opted to forgo medical care because they could not afford it. More than one-quarter (26.8%) reported not having enough money for nutritious meals.
The report cited one study that showed a cancer diagnosis for adolescent and young adult (AYA) survivors leads to average lifetime costs of $259,324.
The FDA approved two targeted therapies for children and AYAs in the past year.
Tovorafenib (Ojemda, Day One Biopharmaceuticals) is approved to treat low-grade BRAF-mutated glioma among children aged at least 6 months who developed recurrent disease or who did not respond to other treatments. Repotrectinib (Augtyro, Bristol Myers Squibb) is indicated for the treatment of patients aged 12 years or older with solid tumors that have a neurotrophic tyrosine receptor kinase gene fusion.
Therapeutic advances
Overall cancer mortality in the United States dropped 33% from 1991 to 2021 — a decline the report’s authors say equates to an estimated 4.1 million lives saved.
The reduction stems in part from steady declines in death rates for colorectal cancer and female breast cancer, accelerated declines in lung cancer mortality, and reductions in death rates for melanoma, leukemia and kidney cancer.
The number of cancer survivors in the United States — which stood at 18 million as of Jan. 1, 2022 — could increase to 26 million by 2040.
Development of novel cancer treatments has contributed to improved survival.
The FDA approved 15 new anti-cancer therapeutics in the past year, including the adoptive cell therapy lifileucel (Amtagvi, Iovance Biotherapeutics) for melanoma and the bispecific antibody tarlatamab-dlle (Imdelltra, Amgen) for small cell lung cancer.
The FDA also granted additional indications to 15 previously approved therapeutics, as well as multiple AI technologies to improve detection and diagnosis.
“What we’re going to do over the next 5 to 10 years is going to be transformational and it’s going to lead to not only 18 million cancer survivors, it’s going to lead to 50 million,” Cleveland said.
Alcohol and other risk factors
The number of cancer diagnoses in the United States is expected to increase from 1.83 million in 2022 to 2.53 million in 2050, according to the report.
Cancer deaths are projected to rise from 600,000 to 970,000.
Modifiable risk factors — including excess body weight, physical inactivity, smoking and alcohol use — are expected to be significant contributors to these trends, as they are associated with 40% of all cancers.
Excessive alcohol intake has been linked to increased risk for breast, colorectal, liver and stomach cancers; esophageal squamous cell carcinoma; and certain head and neck cancers.
A study published in 2019 suggested 5.4% of all cancers in the U.S. could be attributed to alcohol.
However, a survey showed 51% of Americans did not know that alcohol can increase cancer risk.
The report’s authors cited research that suggested individuals who reduce alcohol consumption or stop drinking could reduce their overall cancer risk by 4% and their risk for alcohol-related cancers by 8% compared with those who maintain or increase alcohol consumption.
Policy changes related to alcohol could benefit individuals, such as label warnings and increased pricing and taxes, Michael Pignone, MD, MPH, faculty director for primary care transformation and innovation at Duke University’s Margolis Institute for Health Policy, said during the presentation.
However, he added clinicians need to do their part, too.
“We don’t, as a group, do a great job of asking people about unhealthy alcohol use, and we certainly don’t do as good of job as we could about giving them effective therapies, including brief behavioral interventions and — in patients with more severe disease — pharmacotherapy for alcohol use disorder,” he said.
Additional key points
Other notable findings in the report include:
- More than 40% of individuals diagnosed with cancer will deplete their life savings within 2 years of starting treatment. “If you’re starting out with limited savings, the impact of cancer diagnosis can be devastating financially for people,” Pignone said.
- The worldwide economic burden of cancer has been estimated to eclipse $25 trillion between 2020 and 2050.
- Even though the HPV vaccine can prevent certain cancers, incidence of some such malignancies are on the rise. For example, incidence of cervical cancer among women aged 30 to 34 years increased 2.5% per year between 2012 and 2019.
- Rates for HPV vaccination in the U.S. remain low, as 38.6% of individuals aged 9 to 17 years received the vaccine in 2022. “We really have the opportunity to make cervical cancer a rare disease in the next 5 or 10 years with a little more attention to HPV vaccination and getting people who haven’t been screened, screened,” Pignone said. “The benefits of HPV vaccination also accrue to men, and for all people in reducing head and neck cancer.”
- Rates for breast, colorectal and certain other cancers have increased for individuals aged younger than 50 years.
- Stress needs more research. “The cancer field is rapidly recognizing that stress is a major risk factor for developing cancer,” Cleveland said. “You can actually put a mouse under a stressful regiment and watch it develop a tumor. Stress increases our risk for inflammation and inflammation is tightly linked to many kinds of cancers. So, we need to put more research into this and really pay attention to wellness — upfront before a patient gets treatment and after they get treatment.”
Funding needed
AACR called on Congress to dedicate at least $51.3 billion to the NIH and $7.93 billion to NCI in the fiscal year 2025 budget.
The association also asked for $472.4 million for the CDC’s Division of Cancer Prevention and $55 million for the FDA’s Oncology Center of Excellence in fiscal year 2025, as well as $3.6 billion for Cancer Moonshot activities through 2026.
“It is unquestionable that we are in a time of unparalleled opportunities in cancer research,” Patricia M. LoRusso, DO, PhD, FAACR, AACR President and professor and chief of the early phase clinical trials program at Yale University, said during the presentation. “Not increasing investment in cancer research will impede this momentum against cancer.”
References:
- AACR Cancer Progress Report 2024. Published Sept. 18, 2024. Accessed Sept. 18, 2024.
- AACR Cancer Progress Report highlights innovative research, novel treatments, and powerful patient stories (press release). Published Sept. 18, 2024. Accessed Sept. 18, 2024.
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