TOPLINE

Adolescents and young adults (AYAs) with cancer in the United States experienced slower improvement in survival than younger and older patients before 1998 but have since shown greater improvement rates. From 2000 to 2017, AYAs achieved an average annual percent change (AAPC) surpassing both younger and older patients.

METHODOLOGY

• In 1996, an adolescent gap in cancer treatment and survival was observed, and by 2000, when the Children’s Cancer Group evaluated its progress as a function of patient age, the relative lack of progress in older AYA patients with cancer became obvious. In 2006, the National Cancer Institute (NCI) and NCI-sponsored cooperative groups formally recognized and defined AYA cancer as a distinct discipline with inferior survival trends, inadequate access to research trials, underrepresentation in cancer research, and unique survivorship and fertility issues.
• In the study, researchers analyzed annual survival data from eight US SEER regions during 1975-2017, comparing AYA patients aged 15-39 years with younger patients (0-14 years) and older patients (40-59 years and ≥ 65 years). A total of 3,313,826 individuals diagnosed with cancer between 1975 and 2017 were included in the analytic cohort; of these, 1,691,392 were males and 1,622,434 were females. The age groups of 0-14 years, 15-39 years, 40-64 years, and 65 years or older had 14,985; 214,217; 1,345,282; and 1,739,342 patients, respectively. 
• Joinpoint regression analysis was used to identify time trends and statistical significances in 5-year relative survival rates, with AAPC determined both with and without deaths from HIV/AIDS-associated malignancies including Kaposi sarcoma, diffuse large B-cell lymphoma, and Burkitt lymphoma. 
• Analysis compared survival trends before the end of the HIV/AIDS era (1975-1997) with survival since (1998-2017) because the HIV epidemic during 1981-1998 was associated with a distinct decrease in cancer survival rates in AYA males. 
• Outcome measures included 5-year relative survival rates stratified by sex and age groups, with specific attention to the impact of excluding HIV-associated cancers on survival improvement trends. 

TAKEAWAY

• During 1975-1997, combined AYA males and females had significantly lower improvement in 5-year relative survival (AAPC, 0.52) than those younger than 15 years (AAPC, 1.47), those aged 40-64 years (AAPC, 1.33), and those aged 65 years or older (AAPC, 1.73). 
• During 1998-2017, AYA males exhibited the highest improvement in 5-year relative survival (AAPC, 0.55), though differences between age groups were not statistically significant compared with all other age groups: younger than 15 years (AAPC, 0.52), 40-64 years (AAPC, 0.49), and 65 years or older (AAPC, 0.13; 95% CI, -0.04 to 0.30). 
• Including the HIV-associated cancers, the 2000-2017 AAPC was 0.47 in AYAs and statistically significantly greater than 0.40, 0.42, and 0.38 in patients younger than 15 years, those aged 40-64 years, and those aged 65 years or older, respectively. 
• According to the authors, there has been no divergence of the overlap in overall and relative survival trends for both AYA females and males since 1975, indicating that more recent and aggressive therapies have not caused more therapy-related deaths such as cardiac, renal, pulmonary, or central nervous system toxicities, second malignant neoplasms, or fatal psychiatric sequelae. 

IN PRACTICE

“While compared with younger and older patients with cancer, American AYAs had the slowest improvement in 5-year relative survival before 1998, they since have had a greater improvement rate. Much of this progress can be attributed to national efforts led by NCI-funded cooperative groups to focus on AYA oncology,” the authors of the study wrote.

SOURCE

The study was led by Ivan M. Marrufo, MPH, Texas College of Osteopathic Medicine, The University of North Texas Health Science Center, Fort Worth. It was published online on August 20 in JCO Oncology Practice. 

LIMITATIONS

The study was limited by the SEER8 regions’ population sample size representing approximately 8% of the United States. The SEER database lacks detailed information on cancer stage, treatment regimens, clinical trial participation, comorbidities, and socioeconomic factors during the time periods evaluated. Although exclusion of HIV/AIDS-associated malignancies clarifies therapeutic trends, residual confounding related to HIV status cannot be entirely excluded. Improvements in diagnostic accuracy of AYA cancers and classification over time might have influenced observed survival gains.

DISCLOSURES

No funding sources or conflict of interest statements are provided in the study for Marrufo. Mackenzie J. Ewart, DO, disclosed employment with Texas Health Resources. Archie Bleyer, MD, reported receiving royalties from Springer Nature Book, with payments less than $500 annually until the book’s next edition. Cody W. Dorton, DO, disclosed receiving institutional research funding from Artivion.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.