In the Journals

Nearly one-third of AYA patients do not receive adequate cancer therapy

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November 7, 2014

About 30% of adolescents and young adults with cancer do not receive appropriate initial treatment, according to study results.

Arnold L. Potosky, PhD, director of health services research at Georgetown University’s Lombardi Comprehensive Cancer Center, and colleagues reviewed initial cancer treatments for a population-based sample of 504 adolescent and young adult (AYA) patients diagnosed with acute lymphoblastic leukemia, Hodgkin’s or non-Hodgkin’s lymphoma, germ cell cancer or sarcoma. Patients ranged in age from 15 to 39 years, and they all were diagnosed in 2007 or 2008.

Researchers mailed questionnaires to patients to assess various aspects of their cancer care, including cancer impact, health-related quality of life and delivery of health care. Researchers also sent requests for the release of medical information, as well as forms to be completed by the treatment facility and providers.

From these sources, the researchers extracted information about patient demographics, insurance status and comorbidities. They also were able to obtain information about the facility where initial treatment was provided, physician subspecialties involved in initial treatment, tumor characteristics and staging, and the diagnostic procedures performed.

Potosky and colleagues defined appropriate therapy as the most favorable treatment modality based on cancer type, tumor node metastasis staging, and other pathologic or histological characteristics.

The researchers performed bivariable analysis of appropriate therapy based on patient and health care facility characteristics, and used multivariable logistic regression to evaluate the link between each variable and the obtaining of appropriate therapy.

The researchers found that about 75% of patients evaluated in the study received appropriate initial therapy. However, when male patients with stage I germ cell cancer were excluded, the percentage of patients who received appropriate therapy declined to 68%.

Multivariable analyses revealed a statistically significant association between appropriate treatment and cancer type (P<.01) and clinical trial participation (P=.04). Appropriate therapy was more likely for those enrolled in clinical trials vs. those who did not participate in clinical trials (78% vs. 67%; adjusted OR=2.6; 95% CI, 1.1-6.4).

“There is a sizable and largely unexplained gap in the receipt of appropriate treatment among AYA cancer patients other than those with early-stage male germ cell cancer,” Potosky and colleagues concluded. “Subsequent studies of quality of care should identify new longitudinal AYA cohorts to facilitate a comprehensive investigation of the reason for deficits in appropriate treatment and, perhaps even more critically, whether these apparent deficits are associated with poor clinical and patient-reported outcomes.”

Disclosure: The researchers report no relevant disclosures.

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