Adolescents and young adults with acute lymphoblastic leukemia and acute myeloid leukemia: Impact of care at specialized cancer centers on survival outcome

Academic Article

Abstract

  • Background: Adolescents and young adults (AYA; 15-39 years) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared with children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC) or Children's Oncology Group sites (COG) on survival disparities remains unstudied. Methods: Using the Los Angeles cancer registry, we identified 1,870 ALL or AML patients between 1 and 39 years at diagnosis. Cox regression analyses assessed risk of mortality; younger age CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. Results: ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21 years: HR = 1.9, P = 0.005; 22-29 years: HR = 2.6, P < 0.001; 30-39 years: HR = 3.0, P < 0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21 years: HR = 1.3, P = 0.3; 22-29 years: HR = 1.2, P = 0.2) but wasinferior for 30-to39-year-olds (HR =3.4, P < 0.001).AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21 years: HR = 1.8, P = 0.02; 22-39 years: HR = 1.4, P = 0.06). Outcome at CCC/COG was comparable between children and15-to21-year-olds(HR =1.3, P=0.4)but wasinferiorfor22-to 39-year-olds (HR = 1.7, P = 0.05). Access: 15-to 21-year-olds were less likely to use CCC/COG than children (P < 0.001). In 22-to 39-year-olds, public/uninsured (ALL: P = 0.004; AML<0.001), African American/Hispanics (ALL: P = 0.03), and 30-to 39-yearolds (ALL: P = 0.03) were less likely to use CCC/COG. Conclusions: Poor survival in AYAs with ALL and AML is mitigated by careat CCC/COG. Barriersto CCC/COG care include public/uninsured, and African American/Hispanic race/ethnicity. Impact: Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers.
  • Digital Object Identifier (doi)

    Author List

  • Wolfson J; Sun CL; Wyatt L; Stock W; Bhatia S
  • Start Page

  • 312
  • End Page

  • 320
  • Volume

  • 26
  • Issue

  • 3