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Beauchemin MP, Ji L, Williams AM, Nightingale CL, Dressler EV, Salsman JM, Santacroce SJ, Freyer DR, Roth ME, Parsons SK. Defining Practice Capacity for Cancer Care Delivery to Adolescents and Young Adults in the Community Setting: 2022 Landscape Assessment Results. J Adolesc Young Adult Oncol 2024; 13:557-563. [PMID: 38394227 PMCID: PMC11296314 DOI: 10.1089/jayao.2023.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Background: Adolescents and young adults (AYAs) commonly receive cancer care in the community setting, but the availability of treatment options, resources, and support services for this population is not well known. The National Cancer Institute Community Oncology Research Program (NCORP) funds a network of practices whose mission is to increase access to cancer care and clinical trials in the community setting. We describe our interdisciplinary methodological approach to identify and characterize NCORP practices where AYAs receive cancer care. Methods: NCORP practices completed a cross-sectional Landscape Assessment to describe resources and practice characteristics. We established an interdisciplinary team of stakeholders to analyze the Landscape Assessment data relating to AYAs. Through an iterative process, we assessed NCORP practice responses to questions assessing AYA cancer care capacity, determined a threshold to define practices treating AYAs, and characterized these practices. Results: We determined that practices provide cancer care to AYAs if the following criteria were met: (1) endorsed having an AYA program (n = 20), (2) AYAs comprised ≥5% of annual cancer cases (n = 55), or (3) the practice treated ≥50 AYA cancer cases annually (n = 70). Of 271 NCORP practices, 100 (37%) met any criteria, whereas 87 (32%) did not; 84 (31%) could not be classified due to missing or unknown data. Conclusion: Using an interdisciplinary process, we define practices that treat AYAs in the community. We posit a uniform approach to examine resources and practice capacity for AYAs receiving cancer care across the United States to guide future AYA-focused cancer care delivery research development.
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Affiliation(s)
- Melissa P. Beauchemin
- Division of Scholarship and Research, School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Lingyun Ji
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - AnnaLynn M. Williams
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Chandylen L. Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Emily V. Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sheila J. Santacroce
- School of Nursing and Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - David R. Freyer
- Children's Hospital Los Angeles and USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K. Parsons
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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Wolfson JA, Grimes AC, Nuno M, Bergheimer CL, Ramakrishnan S, Beauchemin M, Dickens D, Levine JM, Roth ME, Scialla M, Woods W, Vargas S, Boayue KB, Chang GJ, Stock W, Hershman D, Curran E, Advani A, O’Dwyer K, Luger S, Liu JJ, Freyer D, Sung L, Parsons SK. Characteristics of Health Care Settings Where Adolescents and Young Adults Receive Care for ALL. JCO Oncol Pract 2024; 20:491-502. [PMID: 38252911 PMCID: PMC11085951 DOI: 10.1200/op.23.00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Individuals diagnosed with cancer between 15 and 39 years (adolescent and young adult [AYA]) face unique vulnerability. Detail is lacking about care delivery for these patients, especially those with ALL. We address these knowledge gaps by describing AYA ALL care delivery details at National Cancer Institute Community Oncology Research Program (NCORP) (sub)affiliates by model of care. METHODS Participating institutions treated at least one AYA with ALL from 2012 to 2016. Study-specific criteria were used to determine the number of unique clinical facilities (CFs) per NCORP and their model of care (adult/internal medicine [IM], pediatric, mixed [both]). Surveys completed by NCORPs for each CF by model of care captured size, resources, services, and communication. RESULTS Among 84 participating CFs (adult/IM, n=47; pediatric, n=15; mixed, n=24), 34% treated 5-10 AYAs with ALL annually; adult/IM CFs more often treated <5 (adult/IM, 60%; pediatric, 40%; mixed, 29%). Referral decisions were commonly driven by an age/diagnosis combination (58%), with frequent ALL-specific age minimums (87%) or maximums (80%). Medical, navigational, and social work services were similar across models while psychology was available at more pediatric CFs (pediatric, 80%; adult/IM, 40%; mixed, 46%-54%). More pediatric or mixed CFs reported oncologists interacting with pediatric/adult counterparts via tumor boards (pediatric, 93%; adult/IM, 26%; mixed, 96%) or initiating contact (pediatric, 100%; adult/IM, 77%; mixed 96%); more pediatric CFs reported an affiliated counterpart (pediatric, 53%; adult, 19%). Most CFs reported no AYA-specific resources (79%) or meetings (83%-98%). CONCLUSION System-level aspects of AYA ALL care delivery have not been examined previously. At NCORPs, these characteristics differ by models of care. Additional work is ongoing to investigate the impact of these facility-level factors on guideline-concordant care in this population. Together, these findings can inform a system-level intervention for diverse practice settings.
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Affiliation(s)
- Julie A. Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Allison C. Grimes
- Division of Pediatric Hematology-Oncology, University of Texas Health Science Center San Antonio
| | - Michelle Nuno
- Children’s Oncology Group
- Department of Population and Public Health Sciences, University of Southern California
| | | | | | | | - David Dickens
- Division of Pediatric Hematology-Oncology, University of Iowa
| | - Jennifer M. Levine
- Division of Pediatric Hematology-Oncology, Children’s National Medical Center
| | - Michael E. Roth
- Division of Pediatric Hematology-Oncology, MD Anderson Cancer Center
| | | | - Wendy Woods
- Division of Pediatric Hematology-Oncology, Blank Children’s Hospital
| | | | - Koh B. Boayue
- Division of Pediatric Hematology-Oncology, University of New Mexico Cancer Center
| | - George J. Chang
- Alliance Cancer Care Delivery Research; Department of Colon and Rectal Surgery and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center
| | - Wendy Stock
- Alliance Leukemia; Division of Hematology-Oncology, University of Chicago Medicine
| | - Dawn Hershman
- SWOG Cancer Care Delivery Research; Division of Hematology-Oncology, Columbia University
| | - Emily Curran
- Alliance Leukemia; Division of Hematology-Oncology, University of Cincinnati
| | - Anjali Advani
- SWOG Leukemia; Division of Hematologic Oncology and Blood Disorders, Cleveland Clinic, Taussig Cancer Institute
| | - Kristen O’Dwyer
- SWOG Leukemia; Division of Hematology-Oncology, University of Rochester, Wilmot Cancer Institute
| | - Selina Luger
- ECOG-ACRIN Leukemia, Division of Hematology-Oncology, University of Pennsylvania
| | - Jane Jijun Liu
- Alliance Community Oncology; Heartland NCORP, Division of Hematology-Oncology, Illinois CancerCare
| | - David Freyer
- Division of Pediatric Hematology-Oncology, Children’s Hospital Los Angeles
| | - Lillian Sung
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children
| | - Susan K. Parsons
- Division of Hematology/Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center
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Rosenberg SM, McCue S, He J, Lafky JM, Carey LA, Galanis E, Leonard JP, Meyerhardt J, Ng K, Schwartz GK, Stock W, Paskett ED, Partridge AH, George S. Alliance A151945: Accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017. Cancer 2024; 130:750-769. [PMID: 37916800 PMCID: PMC10922614 DOI: 10.1002/cncr.35078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Identifying patient- and disease-specific characteristics associated with clinical trial enrollment of adolescents and young adults (AYAs) with cancer may target efforts to improve accrual. METHODS Alliance for Clinical Trials in Oncology (Alliance) trials opened from January 1, 2000, and closed before January 1, 2018, for common AYA cancers were identified. Proportions of AYAs (aged 18-39 years old) versus non-AYAs (aged ≥40 years old) enrolled by cancer type were summarized by descriptive statistics. Among studies with ≥20 AYAs enrolled, demographic and disease characteristics of AYAs versus non-AYAs were compared with χ2 and Kruskal-Wallis tests. A qualitative review was also conducted of therapeutic trials included in analysis in PubMed through December 31, 2021, that reported AYA-specific survival. RESULTS Among 188 trials enrolling 40,396 patients, AYAs represented 11% (4468 of 40,396) of accrual. AYA accrual varied by cancer type (leukemia, 23.6%; breast, 9.9%; lymphoma, 14.8%; colorectal, 6.2%; central nervous system, 8.1%; melanoma, 11.8%; sarcoma, 12%). Across ages, the proportion of Black and Hispanic patients enrolled was 1%-10%. Compared to non-AYAs, AYAs in breast and colorectal cancer trials were less likely to be White and more likely to be Hispanic. Disease characteristics differed by age for selected trials. Two trials reported AYA-specific survival, with no significant differences observed by age. CONCLUSIONS AYA accrual to Alliance trials was comparable to or exceeded population-based, age-specific prevalence estimates for most cancer types. Greater proportional representation of Hispanic and non-White patients among AYAs reflects US demographic trends. The small number of minority patients enrolled across ages underscores the persistent challenge of ensuring equitable access to trials, including for AYAs.
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Affiliation(s)
| | - Shaylene McCue
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Jun He
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Lisa A. Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, MA
| | - Gary K. Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY
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Travis LB, Feldman DR, Fung C, Poynter JN, Lockley M, Frazier AL. Adolescent and Young Adult Germ Cell Tumors: Epidemiology, Genomics, Treatment, and Survivorship. J Clin Oncol 2024; 42:696-706. [PMID: 37820296 DOI: 10.1200/jco.23.01099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 08/11/2023] [Indexed: 10/13/2023] Open
Abstract
Innovations in the care of adolescent and young adult (AYA) germ cell tumors (GCTs) are needed for one of the most common AYA cancers for which treatment has not significantly changed for several decades. Testicular GCTs (TGCTs) are the most common cancers in 15- to 39-year-old men, and ovarian GCTs (OvGCTs) are the leading gynecologic malignancies in women younger than 25 years. Excellent outcomes, even in widely metastatic disease using cisplatin-based chemotherapy, can be achieved since Einhorn and Donohue's landmark 1977 study in TGCT. However, as the severity of accompanying late effects (ototoxicity, neurotoxicity, cardiovascular disease, second malignant neoplasms, nephrotoxicity, and others) has emerged, efforts to deintensity treatment and find alternatives to cisplatin have taken on new urgency. Current innovations include the collaborative design of clinical trials that accrue GCTs across all ages and both sexes, including adolescents (previously on pediatric trials), and OvGCT (previously on gynecologic-only trials). Joint trials accrue larger sample sizes at a faster rate and therefore evaluate new approaches more rapidly. These joint trials also allow for biospecimen collection to further probe GCT etiology and underlying mechanisms of tumor growth, thus providing new therapeutic options. This AYA approach has been fostered by The Malignant Germ Cell International Consortium, which includes over 115 GCT disease experts from pediatric, gynecologic, and genitourinary oncologies in 16 countries. Trials in development incorporate, to our knowledge, for the first time, molecular risk stratification and precision oncology approaches on the basis of specific GCT biology. This collaborative AYA approach pioneering successfully in GCT could serve as a model for impactful research for other AYA cancer types.
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Affiliation(s)
- Lois B Travis
- Department of Medical Oncology, Indiana University, Indianapolis, IN
| | | | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Michelle Lockley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - A Lindsay Frazier
- Dana Farber-Boston Children's Cancer and Blood Disorders Center, Boston, MA
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Singh S, Nguyen T, Deleemans J, Oberoi D, Piedalue KA, Carlson LE. A Phenomenological Qualitative Exploration of Mind-Body Therapy Use and Effectiveness Among Young, Middle, and Older Adult Cancer Survivors. Integr Cancer Ther 2024; 23:15347354241253847. [PMID: 38767143 PMCID: PMC11107309 DOI: 10.1177/15347354241253847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Having been diagnosed with and treated for cancer can have negative psychosocial repercussions that may differ across the lifespan. Mind-body therapies (MBTs), such as tai-chi/qigong (TCQ) or mindfulness-based cancer recovery (MBCR), have shown promise in decreasing negative psychosocial outcomes in cancer survivors, but few studies have explored potential differences in MBT use and effectiveness across age groups. METHODS A descriptive phenomenological qualitative design was used. Participants included young (18-39), middle (40-64), and older (65+) adult cancer survivors who were diagnosed with any type of cancer and had participated in Mindfulness-Based Cancer Recovery (MBCR) or Tai Chi/Qigong (TCQ) MBTs. Semi-structured qualitative interviews explored participants' experiences in MBTs and these were analyzed using descriptive phenomenological analysis. RESULTS Among the interviews (n = 18), young (n = 6), middle-aged (n = 8), and older (n = 4) adults participated. 5 themes emerged: influences in joining the program, unique lifestyles, positive class experiences, use of media, and program impacts. Though all age groups benefitted from MBT participation, variations between age groups with respect to the benefits received and motivations for joining the program were observed. DISCUSSION MBTs had beneficial physical and mental health effects on survivors of all age groups. These benefits were particularly connected to the ongoing life stresses common to each age cohort, such as relief from work and family roles for young adults or support during retirement transition for older adults. Hence, access to MBT programs may be beneficial as part of the survivorship plan for patients and the recruitment strategies or content can be adapted by MBT providers to better target and support age-specific groups. More research is required with a larger sample.
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Affiliation(s)
- Sarthak Singh
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Tina Nguyen
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Julie Deleemans
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Devesh Oberoi
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
| | - Katherine-Ann Piedalue
- Department of Science, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Linda E. Carlson
- Cumming School of Medicine, Department of Oncology, Division of Psychosocial Oncology, University of Calgary, Calgary, AB, Canada
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Abstract
BACKGROUND Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.
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Baclig NV, Comulada WS, Ganz PA. Mental health and care utilization in survivors of adolescent and young adult cancer. JNCI Cancer Spectr 2023; 7:pkad098. [PMID: 37982744 PMCID: PMC10735415 DOI: 10.1093/jncics/pkad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Adolescent and young adult cancer survivors experience mental health challenges, yet little is known about the evolution of these difficulties. This study explored mental health symptoms and utilization among long-term adolescent and young adult cancer survivors. METHODS Using 30 432 respondents from the 2019 National Health Interview Survey, this study compared adults with a history of adolescent and young adult cancer (diagnosed when patients were between 15 and 39 years of age) to adults without adolescent and young adult cancer. Mental health symptom severity was measured using the Patient Health Questionnaire depression scale and 7-item Generalized Anxiety Disorder questionnaires. Care utilization constituted psychotherapy and mental health medication use. Inverse propensity score weights were used to balance demographics and combined with survey weights. Descriptive statistics, multivariable generalized linear models, and structural equation modeling with 2-sided tests were used for analysis. RESULTS We compared 639 adolescent and young adult survivors with 29 793 controls. Survivors were, on average, 20.5 years (SE = 0.74) past their cancer diagnosis dates. After adjusting for survey and propensity score weights, adolescent and young adult survivors reported more severe depression (incidence rate ratio = 1.42, 95% confidence interval [CI] = 1.09 to 1.84, P < .01) and anxiety (incidence rate ratio = 1.85, 95% CI = 1.55 to 2.21, P < .001). They were more likely to use psychotherapy (odds ratio = 1.91, 95% CI = 1.16 to 3.17, P < .05) and mental health medications (odds ratio = 1.89, 95% CI = 1.15 to 3.11, P < .05). Time since diagnosis was negatively associated with symptoms and utilization. Structural equation modeling demonstrated mediation of utilization effect by symptom severity. CONCLUSIONS Adolescent and young adult survivors experience worse mental health in late survivorship, despite small improvements over time. We highlight the importance of survivorship care that addresses the long-term mental health needs of these survivors.
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Affiliation(s)
- Nikita V Baclig
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Jonasson K, Sjövall J, Holmberg E, Beran M, Niklasson M, Kristiánsson S, Sandström K, Wennerberg J. Squamous cell carcinoma of the mobile tongue in young adults: A Swedish head & neck cancer register (SweHNCR) population-based analysis of prognosis in relation to age and stage. Oral Oncol 2023; 144:106485. [PMID: 37451141 DOI: 10.1016/j.oraloncology.2023.106485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Increased incidence of squamous cell carcinoma (SCC) of the tongue has been reported in young adults (YA) in several countries since the 1980s and confirmed in later studies. The etiology is unclear, the prognosis has been debated, and conflicting results have been published. Some studies show better survival in young adults than in older patients, some worse, and others no difference. Most studies are based on selected series or include other sites in the oral cavity. The definition of "YA" is arbitrary and varies between studies. It is thus difficult to use in general conclusions. This work uses data from the population-based Swedish Head and Neck Cancer register (SweHNCR), which has > 98% coverage. SweHNCR data includes age, gender, TNM, treatment intention, treatment given, lead times, performance status, and to a lesser degree, smoking habits. The current Swedish population is around 10 million. We analyzed outcomes for 1416 patients diagnosed with SCC of the oral tongue from 2008 to 2017 using 18-39 years to define YA age because it is the range most commonly used. We found no significant difference in relative survival (a proxy for diagnosis-specific survival) between age groups of patients treated with curative intent for SCC of the oral tongue. The stage at time of diagnosis was equally distributed among the age groups. Excess mortality rate correlated mainly with stage, subsite of the tongue, performance status, and lead time to treatment.
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Affiliation(s)
| | - Johanna Sjövall
- Dept of Otolaryngology/H&N Surgery, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden.
| | - Erik Holmberg
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden; The Swedish Head and Neck Cancer Register (SweHNCR), Sweden
| | - Martin Beran
- The Swedish Head and Neck Cancer Register (SweHNCR), Sweden; Department of ENT and Maxillofacial Surgery, NAL Medical Center Hospital, Trollhättan, Sweden
| | - Magnus Niklasson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Kristiánsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Örebro University Hospital, Örebro, Sweden
| | - Karl Sandström
- Otolaryngology, Department of Surgical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Johan Wennerberg
- Dept of Otolaryngology/H&N Surgery, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital, Lund, Sweden
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Mersin S, Gülük F, Gülcan E, Eşkazan AE. Current and emerging tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia in young adults. Expert Opin Pharmacother 2023; 24:1703-1713. [PMID: 37482425 DOI: 10.1080/14656566.2023.2240702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is more common in older adults, but nearly 15-20% of the patients is between 15 and 39 years of age. In this age group, patients may seek clinical care a much later period of the disease and they may have a heavier burden of disease. In addition, young patients with CML may face unique challenges related to their age, such as concerns about health care, fertility, or careers. The current standard of care for CML is the use of tyrosine kinase inhibitors (TKIs), which induce remission in most young patients and can achieve long-term disease control. AREAS COVERED This review summarizes age-specific treatment-related conditions, as well as the effectiveness of TKI therapy in this age group. PubMed, Google Scholar, clinicaltrials.gov and other abstract databases were used while preparing this review. The period of 2001-2023 was chosen as the search window. EXPERT OPINION Although we do not have sufficient data, young adult population has a special importance for TKI treatment. Clinical features, efficacy of treatments, and specific conditions in this age group should attract more attention of clinicians and more intensive studies should be conducted in the future.
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Affiliation(s)
- Sinan Mersin
- Department of Hematology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Fatih Gülük
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emirhan Gülcan
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Thompson EC, Owen J, Wolfson JA, Arbuckle JL. Menstrual Suppression in the Myelosuppressed: A Retrospective Cohort Study. JCO Oncol Pract 2023; 19:586-594. [PMID: 37220317 DOI: 10.1200/op.22.00841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/01/2023] [Accepted: 03/17/2023] [Indexed: 05/25/2023] Open
Abstract
PURPOSE Adolescent and young adult female patients receiving myelosuppressive cancer treatments are at risk of abnormal uterine bleeding (AUB). The frequency with which patients with cancer receive menstrual suppression and the agents used have not previously been well-characterized. We studied the rate of menstrual suppression, the effect of suppression on bleeding and blood product utilization, and if there were practice pattern differences between adult and pediatric oncologists. METHODS We established a retrospective cohort of 90 females with a diagnosis of Hodgkin or non-Hodgkin lymphoma (n = 25), AML (n = 46), or sarcoma (n = 19) and treated with chemotherapy between 2008 and 2019 at our institutions (University of Alabama at Birmingham [UAB] adult oncology: UAB hospital; UAB pediatric oncology: Children's of Alabama). Data were abstracted from the medical record including sociodemographics, primary oncologist specialty (pediatric v adult), cancer details (diagnosis and treatment) and gynecologic course (documented gynecologic history, menstrual suppression agents used, reported AUB outcomes, and treatments). RESULTS The majority of patients (77.8%) received menstrual suppression. Compared with nonsuppressed patients, suppressed patients had similar rates of packed red blood cell transfusions but higher number of platelet transfusions. Adult oncologists were more likely to document a gynecologic history, consult gynecology, and list AUB as a problem. Among suppressed patients, there was heterogeneity in the agents used for menstrual suppression, with a predilection toward progesterone-only agents; a low rate of thrombotic events was observed. CONCLUSION Menstrual suppression was common in our cohort with variability in agents used. Pediatric and adult oncologists demonstrated different practice patterns.
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Affiliation(s)
- Emma C Thompson
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - John Owen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Julie A Wolfson
- Division of Hematology-Oncology, Department of Pediatrics, Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Janeen L Arbuckle
- Division of Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Pappas L, Baiev I, Reyes S, Bocobo AG, Jain A, Spencer K, Le TM, Rahma OE, Maurer J, Stanton J, Zhang K, De Armas AD, Deleon TT, Roth M, Peters MLB, Zhu AX, Boyhen K, VanCott C, Patel T, Roberts LR, Lindsey S, Horick N, Lennerz JK, Iafrate AJ, Goff LW, Mody K, Borad MJ, Shroff RT, Javle MM, Kelley RK, Goyal L. The Cholangiocarcinoma in the Young (CITY) Study: Tumor Biology, Treatment Patterns, and Survival Outcomes in Adolescent Young Adults With Cholangiocarcinoma. JCO Precis Oncol 2023; 7:e2200594. [PMID: 37561981 PMCID: PMC10581631 DOI: 10.1200/po.22.00594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/06/2023] [Accepted: 04/06/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Increased awareness of the distinct tumor biology for adolescents and young adults (AYAs) with cancer has led to improvement in outcomes for this population. However, in cholangiocarcinoma (CCA), a paucity of data exist on the AYA population. To our knowledge, we present the largest study to date on AYA disease biology, treatment patterns, and survival outcomes in CCA. METHODS A multi-institutional cohort of patients with CCA diagnosed with intrahepatic cholangiocarcinoma (ICC) or extrahepatic cholangiocarcinoma (ECC) was used for analysis. Retrospective chart review was conducted on patients who were 50 years old and younger (young; n = 124) and older than 50 years (older; n = 723). RESULTS Among 1,039 patients screened, 847 patients met eligibility (72% ICC, 28% ECC). Young patients had a larger median tumor size at resection compared with older patients (4.2 v 3.6 cm; P = .048), more commonly had N1 disease (65% v 43%; P = .040), and were more likely to receive adjuvant therapy (odds ratio, 4.0; 95% CI, 1.64 to 9.74). Tumors of young patients were more likely to harbor an FGFR2 fusion, BRAF mutation, or ATM mutation (P < .05 for each). Young patients were more likely to receive palliative systemic therapy (96% v 69%; P < .001), targeted therapy (23% v 8%; P < .001), and treatment on a clinical trial (31% v 19%; P = .004). Among patients who presented with advanced disease, young patients had a higher median overall survival compared with their older counterparts (17.7 v 13.5 months; 95% CI, 12.6 to 22.6 v 11.4 to 14.8; P = .049). CONCLUSION Young patients with CCA had more advanced disease at resection, more commonly received both adjuvant and palliative therapies, and demonstrated improved survival compared with older patients. Given the low clinical trial enrollment and poor outcomes among some AYA cancer populations, data to the contrary in CCA are highly encouraging.
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Affiliation(s)
- Leontios Pappas
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Islam Baiev
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Andrea Grace Bocobo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Apurva Jain
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kristen Spencer
- Department of Medicine, NYU Langone Health Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Tri Minh Le
- Department of Medicine, University of Virginia Comprehensive Cancer Center, Charlottesville, VA
| | - Osama E. Rahma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jordan Maurer
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jen Stanton
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Karen Zhang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Anaemy Danner De Armas
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Marc Roth
- Department of Medical Oncology, St Luke's Cancer Institute, Kansas City, MO
| | | | - Andrew X. Zhu
- Jiahui International Cancer Center, Jiahui Health, Shanghai, China
- I-MAB Biopharma, Shanghai, China
| | | | | | - Tushar Patel
- Department of Transplantation, Mayo Clinic, Jacksonville, FL
| | - Lewis R. Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Nora Horick
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Jochen K. Lennerz
- Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - A. John Iafrate
- Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Kabir Mody
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
| | - Mitesh J. Borad
- Division of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ
| | - Rachna T. Shroff
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | - Milind M. Javle
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R. Katie Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Lipika Goyal
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Oncology, Stanford Cancer Center, Palo Alto, CA
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12
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Pecoriello J, Sampson A, Block R, Sutter ME, Vadaparampil ST, Quinn GP. For the LOvE of Reproductive Health Communication: Assessment of the LGBT Oncofertility Education (LOvE) Module. J Adolesc Young Adult Oncol 2023; 12:555-560. [PMID: 36459104 PMCID: PMC10457611 DOI: 10.1089/jayao.2022.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: The lesbian, gay, bisexual, transgender, and queer (LGBTQ) Oncofertility Education (LOvE) module aims to improve knowledge on providing inclusive and affirming care for LGBTQ adolescents and young adults (AYAs) with cancer. The objective of this study is to evaluate the role of the module in improving reproductive health communication for the care of LGBTQ AYAs with cancer. Methods: A 10-item multiple-choice pre-test and post-test assessed learner knowledge, with total knowledge scores ranging from 0 (no correct responses) to 10 (all correct responses). A post-module survey and open-ended questions assessed relevance of the module, quality, and appropriateness to professional practice. Paired t-tests analyzed changes in knowledge before and after the module. Content analysis was applied to qualitative responses. Results: Thirty-seven learners completed both the pre-test and post-test. Around 8.1% correctly answered all pre-test questions; 59.5% correctly answered all posttest questions. The average pre-test score was 8.3, versus posttest score of 9.5 (p < 0.0001). Eighty-nine percent of learners strongly agreed that LOvE Enriching Communication Skills for Health Professionals in Oncofertility was relevant to their work; 95% strongly agreed that it was easy to understand and navigate. Open-ended responses highlighted how the module helped learners strengthen the provider-patient relationship in the context of oncofertility, create a safe space for patients, and understand the relevance of educational materials about fertility to LGBTQ patients. Conclusions: We found significant improvement in knowledge of reproductive health care for LGBTQ AYAs with cancer after completing the module. Improving provider knowledge may improve confidence in providing inclusive and affirming care for LGBTQ AYAs with cancer, resulting in improved whole-person care.
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Affiliation(s)
- Jillian Pecoriello
- Department of Obstetrics and Gynecology, New York University, New York, New York, USA
| | - Amani Sampson
- Department of Obstetrics and Gynecology, New York University, New York, New York, USA
| | - Rebecca Block
- Department of Research, Rx4good, Daniel Island, South Carolina, USA
| | - Megan E. Sutter
- Department of Obstetrics and Gynecology, New York University, New York, New York, USA
| | | | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University, New York, New York, USA
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13
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Bennett CR, Raybin JL, Glinzak L, Coats H, Gauthier K, Sousa K, Hendricks-Ferguson VL. Art Unfolds Words: Expressing Hope Through Creative Art Among Adolescents and Young Adults Who Have Advanced Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:245-258. [PMID: 37063060 DOI: 10.1177/27527530221140073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Hope's role in the care of adolescents and young adults (AYAs) who have advanced cancer (AC) is not well understood. This study aimed to conceptualize the essence of hope among AYAs who have AC based on their lived experiences and illustrate hope through verbal and artistic depictions of the AYA's lived experiences. Fifteen AYAs, aged 12 to 21 years, diagnosed with AC completed two semistructured interviews to share their lived experiences of hope perspectives in the form of a descriptive narrative and a creative-art outcome. Participants who chose to draw pictures narrated the conceptual meanings based on elements of each picture. A board-certified art therapist performed a post hoc analysis of the drawings and participants' verbatim descriptions of their meanings. Five of the 15 AYA participants created drawings depicting their lived experiences of hope. The artistic process of mapping their cancer journey revealed distinct views of hope through nature landscapes and metaphors. Participants provided titles for their drawings such as "Over the Rainbow," "Growth in the Valley," and "The Light at the End of the Tunnel." The pictures embodied the AYAs' thoughts, perceptions, and lived experiences related to hope and its role during their cancer journey. Drawing is one simple art form that can facilitate an AYA's expression of well-being (including hope) beyond what may be verbally articulated. Creative art should be further researched as a screening tool to assess how AYAs with AC cope with an uncertain future and psychological and/or existential distress symptoms.
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Affiliation(s)
| | - Jennifer L Raybin
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA
| | - Leara Glinzak
- Palliative Care Consult Service, UCHealth University of Colorado Hospital, Aurora, CO, USA
| | - Heather Coats
- College of Nursing, University of Colorado, Aurora, CO, USA
| | | | - Karen Sousa
- College of Nursing, University of Colorado, Aurora, CO, USA
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14
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Wu S, Liu Y, Williams M, Aguilar C, Ramirez AG, Mesa R, Tomlinson GE. Childhood cancer survival in the highly vulnerable population of South Texas: A cohort study. PLoS One 2023; 18:e0278354. [PMID: 37022991 PMCID: PMC10079030 DOI: 10.1371/journal.pone.0278354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023] Open
Abstract
This study examines childhood cancer survival rates and prognostic factors related to survival in the majority Hispanic population of South Texas. The population-based cohort study used Texas Cancer Registry data (1995-2017) to examine survival and prognostic factors. Cox proportional hazard models and Kaplan-Meier survival curves were used for survival analyses. The 5-year relative survival rate for 7,999 South Texas cancer patients diagnosed at 0-19 years was 80.3% for all races/ethnicities. Hispanic patients had statistically significant lower 5-year relative survival rates than non-Hispanic White (NHW) patients for male and female together diagnosed at age≥5 years. When comparing survival among Hispanic and NHW patients for the most common cancer, acute lymphocytic leukemia (ALL), the difference was most significant in the 15-19 years age range, with 47.7% Hispanic patients surviving at 5 years compared to 78.4% of NHW counterparts. The multivariable-adjusted analysis showed that males had statistically significant 13% increased mortality risk than females [hazard ratio (HR): 1.13, 95% confidence interval (CI):1.01-1.26] for all cancer types. Comparing to patients diagnosed at ages 1-4 years, patients diagnosed at age < 1 year (HR: 1.69, 95% CI: 1.36-2.09), at 10-14 year (HR: 1.42, 95% CI: 1.20-1.68), or at 15-19 years (HR: 1.40, 95% CI: 1.20-1.64) had significant increased mortality risk. Comparing to NHW patients, Hispanic patients showed 38% significantly increased mortality risk for all cancer types, 66% for ALL, and 52% for brain cancer. South Texas Hispanic patients had lower 5-year relative survival than NHW patients especially for ALL. Male gender, diagnosis at age<1 year or 10-19 years were also associated with decreased childhood cancer survival. Despite advances in treatment, Hispanic patients lag significantly behind NHW patients. Further cohort studies in South Texas are warranted to identify additional factors affecting survival and to develop interventional strategies.
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Affiliation(s)
- Shenghui Wu
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, United States of America
| | - Yanning Liu
- Department of Psychology, University of Texas at Austin, Austin, TX, United States of America
| | - Melanie Williams
- Cancer Epidemiology and Surveillance Branch, Texas Cancer Registry, Austin, TX, United States of America
| | - Christine Aguilar
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX, United States of America
- Greehey Children’s Cancer Research Institute, University of Texas Health San Antonio, San Antonio, TX, United States of America
| | - Amelie G. Ramirez
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, United States of America
- Institute for Health Promotion Research, University of Texas Health San Antonio, San Antonio, TX, United States of America
| | - Ruben Mesa
- University of Texas Health San Antonio Mays Cancer Center, San Antonio, TX, United States of America
| | - Gail E. Tomlinson
- Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX, United States of America
- Greehey Children’s Cancer Research Institute, University of Texas Health San Antonio, San Antonio, TX, United States of America
- University of Texas Health San Antonio Mays Cancer Center, San Antonio, TX, United States of America
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15
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Wojcik KY, Hawkins M, Anderson-Mellies A, Hall E, Wysong A, Milam J, Hamilton AS, Cockburn MG. Melanoma survival by age group: Population-based disparities for adolescent and young adult patients by stage, tumor thickness, and insurance type. J Am Acad Dermatol 2023; 88:831-840. [PMID: 36610687 PMCID: PMC10246749 DOI: 10.1016/j.jaad.2022.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Melanoma survival literature predominantly represents patients >65 years of age. Study of younger patients may reveal potential age-group-specific differences in survival outcome. OBJECTIVE Identify factors associated with differences in melanoma survival in 2 age groups, adolescents and young adults (AYAs; ages 15-39) and older adults (ages 40-64). METHODS This population-based registry study included all cases (n = 81,597) of cutaneous melanoma diagnosed at ages 15 to 64 from 2004 to 2015 in California. Age-group-specific multivariable Cox hazard regressions were used. RESULTS In the adjusted, age-group-specific models, AYA patients with stage IV melanoma had worse survival (hazard ratio: 20.39, 95% CI: 13.30-31.20) than was observed among older adults (hazard ratio: 10.79, 95% CI: 9.33-12.48). Thicker tumors and public insurance were also associated with worse survival for AYAs than observed in models for older adults. AYAs experienced better survival when detected at earlier stages. LIMITATIONS Registry data do not routinely collect behavioral information or family history of melanoma. CONCLUSIONS Survival was much worse for AYAs with stage IV melanoma than observed among older adults. To improve AYA survival, early melanoma detection is critical. Greater awareness, suspicion, and screening for AYA melanoma may disrupt delays in diagnosis and reduce the excess burden of mortality from stage IV melanoma in young patients.
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Affiliation(s)
- Katherine Y Wojcik
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
| | - Makenzie Hawkins
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Evan Hall
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California, Irvine, California
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern CA, Los Angeles, California
| | - Myles G Cockburn
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern CA, Los Angeles, California; Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
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16
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Diaz P, Reddy R, Blachman-Braun R, Zucker I, Dullea A, Gonzalez DC, Kresch E, Ramasamy R. Comparison of Intratesticular Testosterone between Men Receiving Nasal, Intramuscular, and Subcutaneous Pellet Testosterone Therapy: Evaluation of Data from Two Single-Center Randomized Clinical Trials. World J Mens Health 2023; 41:390-395. [PMID: 35791295 PMCID: PMC10042650 DOI: 10.5534/wjmh.210261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Testosterone replacement therapy (TRT) can potentially cause decreased spermatogenesis and subsequent infertility. Recent studies have suggested that 17-hydroxyprogesterone (17-OHP) is a reliable surrogate for intratesticular testosterone (ITT) that is essential for spermatogenesis. We evaluated data from two ongoing open-label, randomized, two-arm clinical trials amongst different treatment preparations (Trial I) subcutaneous testosterone pellets (TP) and (Trial II) intranasal testosterone (NT) or intramuscular testosterone cypionate (TC). MATERIALS AND METHODS Seventy-five symptomatic hypogonadal men (2 serum testosterone <300 ng/dL) were randomized into open label randomized clinical trials. Eligible subjects received 800 mg TP, 11 mg TID NT or 200 mg ×2 weeks TC. 17-OHP and Serum testosterone were evaluated at baseline and follow-up. The primary outcome was changes in 17-OHP. Secondary outcome was changes in serum testosterone. Data was analyzed by two-sample and single-sample t-tests, and determination of equal or unequal variances was computed using F-tests. RESULTS Median participant age was 45 years old, with overall baseline 17-OHP of 46 and serum testosterone of 223.5 ng/dL. 17-OHP significantly decreased in subjects prescribed long-acting TP or TC. The 4-month change in 17-OHP in the NT group (-33.3% from baseline) was less than the change seen in TC (-65.3% from baseline) or TP (-44% from baseline) (p=0.005). All testosterone formulations increased serum testosterone levels at follow-up, with the largest increase seen in TC (+157.6%), followed by NT (+114.3%) and TP (+79.6%) (p=0.005). CONCLUSIONS Short-acting nasal testosterone appear to have no impact on serum 17-OHP especially in comparison to long-acting testosterone formulations. All modalities saw significant increases in serum testosterone levels at follow-up. NT and other short acting testosterone formulations may better preserve ITT and be beneficial for hypogonadal men seeking to maintain fertility potential while on TRT.
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Affiliation(s)
- Parris Diaz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rohit Reddy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Isaac Zucker
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexandra Dullea
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Daniel C Gonzalez
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eliyahu Kresch
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
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17
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Zhang Z, Wang J, Song N, Shi L, Du J. The global, regional, and national burden of stomach cancer among adolescents and young adults in 204 countries and territories, 1990-2019: A population-based study. Front Public Health 2023; 11:1079248. [PMID: 36908483 PMCID: PMC9998989 DOI: 10.3389/fpubh.2023.1079248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Background Stomach cancer is a significant health problem in many countries. But healthcare needs of adolescents and young adults (AYAs) stomach cancer patients have been historically neglected. An accurate appraisal of the burden of AYA stomach cancer is crucial to formulating effective preventive strategies. In this study, we report the most recent estimates of AYA stomach cancer burden concerning socio-demographic index (SDI) in 204 countries and territories between 1990 and 2019. Methods Estimates from the Global Burden of Disease study 2019 were used to analyze incidence, mortality, and disability-adjusted life years (DALYs) due to AYA stomach cancer at global, regional, and national levels. Association between AYA stomach cancer burden and SDI were investigated. All estimates are reported as absolute numbers and age-standardized rates, which were standardized to the GBD world population and reported per 100,000 population. Results In 2019, there were 49,000 incident cases, 27,895 deaths, and 1.57 million DALYs due to AYA stomach cancer globally. The highest age-standardized incidence rate occurred in East Asia [2.42 (women) and 4.71 (men) per 100,000 person-years] and high-income Asia Pacific [3.16 (women) and 2.61 (men) per 100,000 person-years]. Age-standardized death [1.53 (women) and 2.65 (men) per 100,000 person-years] and DALY [150.96 (women) and 87.13 (men) per 100,000 person-years] rates were highest in Oceania. Compared with 1990, in 2019 more than 1,075 more incident cases of AYA stomach cancer were estimated with a decrease of 7,784 deaths. Despite the increase in absolute number of incident cases, the worldwide age-standardized rates of AYA stomach cancer (incidence, deaths, and DALYs) have declined since 1990. The drop in the disease burden was associated with an improved SDI. Globally, 24.41% of the age-standardized DALYs were attributable to a high-sodium diet in both sexes combined, and 0.57% of the age-standardized DALYs were attributable to smoking in men. Conclusion The global burden of AYA stomach cancer is substantial, especially in developing regions. Capacity-building activities for AYA stomach cancer will benefit the younger generation and population health worldwide.
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Affiliation(s)
- Ziqiang Zhang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ning Song
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liubin Shi
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianjun Du
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
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18
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Wolfson JA, Bhatia S, Bhatia R, Smith MW, Dai C, Campbell SB, Gunn DD, Mahoney AB, Croney CM, Hageman L, Francisco L, Kenzik KM. Using Teamwork to Bridge the Adolescent and Young Adult Gap. JCO Oncol Pract 2023; 19:e150-e160. [PMID: 36215685 DOI: 10.1200/op.22.00300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Individuals diagnosed with cancer age between 15 and 39 years (adolescents and young adults [AYAs]) have not seen improvement in survival compared with children or older adults; clinical trial accrual correlates with survival. Unique unmet needs among AYAs related to psychosocial support and fertility preservation (FP) are associated with health-related quality of life. METHODS We enhanced existing structures and leveraged faculty/staff across pediatric/adult oncology to create novel teams focused on AYA (age 15-39 years) care at a single center, with minimal dedicated staff and no change to revenue streams. We aimed to influence domains shown to drive survival and health-related quality of life: clinical trial enrollment, physician/staff collaboration, psychosocial support, and FP. We captured metrics 3 months after patients presented to the institution and compared them before/after Program implementation using descriptive statistics. RESULTS Among 139 AYAs (age 15-39 years) from the pre-Program era (January 2016-February 2019: adult, n = 79; pediatric, n = 60), and 279 from the post-Program era (February 2019-March 2022: adult, n = 215; pediatric, n = 64), there was no change in clinical trial enrollment(P ≥ .3), whereas there was an increase in the proportion of AYAs referred for supportive care and psychology (pediatric: P ≤ .02; adult: P ≤ .001); whose oncologists discussed FP (pediatric: 15% v 52%, P < .0001; adult: 37% v 50%, P = .0004); and undergoing FP consults (pediatric: 8% v39%, P < .0001; adult 23% v 38%, P = .02). CONCLUSION This team-based framework has effected change in most targeted domains. To affect all domains and design optimal interventions, it is crucial to understand patient-level and facility-level barriers/facilitators to FP and clinical trial enrollment.
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Affiliation(s)
- Julie A Wolfson
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Bhatia
- Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Mark W Smith
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Sukhkamal B Campbell
- Division of Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, AL
| | - Deidre D Gunn
- Division of Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, AL
| | - Anne Byrd Mahoney
- Division of Pediatric Hematology-Oncology, Vanderbilt University, Birmingham, AL
| | - Christina M Croney
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Lindsey Hageman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.,Division of Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
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19
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Cherven B, Kelling E, Lewis RW, Pruett M, Meacham L, Klosky JL. Fertility-related worry among emerging adult cancer survivors. J Assist Reprod Genet 2022; 39:2857-2864. [PMID: 36447078 PMCID: PMC9790831 DOI: 10.1007/s10815-022-02663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Cancer survivors with a history of gonadotoxic treatment are at risk for future infertility and reproductive concerns, including worry about infertility. The purpose of this study was to describe factors associated with fertility-related worry among emerging adult survivors of childhood cancer. METHODS This chart review included patients aged 18.00-25.99 years and > 1 year from cancer treatment completion with a history of gonadotoxic treatment. Survivors were offered structured fertility-focused discussions at age ≥ 18 years, which assessed worry about future infertility. Data from this discussion (i.e., reported fertility-related worry (yes/no), sociodemographic, and clinical characteristics were abstracted from the medical record. Multivariable logistic regression with backwards elimination was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI) for factors associated with fertility-related worry. RESULTS Survivors (N = 249) were a mean age of 19.1 ± 1.2 years at initial fertility discussion; 55.8% were male, 58.2% non-Hispanic White, and 27.3% were at high risk for future treatment-related infertility. Fertility-related worry was reported by 66.3% of survivors. Factors related to worry on multivariable analysis included female sex (OR: 2.64, 95%CI: 1.44-4.96, p = .002), solid tumor diagnosis (OR: 2.31, 95%CI: 1.15-4.71, p = .019), moderate and high risk of infertility (OR: 2.94, 95%CI: 1.23-7.64, p = .02; OR: 3.25, 95%CI: 1.55-7.17, p = .002), and ≥ 2 fertility discussions during survivorship care OR: 2.71, 95%CI: 1.46-5.20, p = .002). CONCLUSIONS Two-thirds of emerging adult cancer survivors expressed worry about future infertility, which has been linked to a variety of adverse quality of life outcomes. Survivors who are worried about infertility may benefit from psychological interventions.
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Affiliation(s)
- Brooke Cherven
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Erin Kelling
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Rebecca Williamson Lewis
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Megan Pruett
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
| | - Lillian Meacham
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, 2015 Uppergate Dr, 4th Fl, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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20
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AlZaabi A, AlHarrasi A, AlMusalami A, AlMahyijari N, Al Hinai K, ALAdawi H, Al-Shamsi HO. Early onset colorectal cancer: Challenges across the cancer care continuum. Ann Med Surg (Lond) 2022; 82:104453. [PMID: 36268309 PMCID: PMC9577444 DOI: 10.1016/j.amsu.2022.104453] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/13/2022] [Accepted: 08/13/2022] [Indexed: 11/26/2022] Open
Abstract
Early Onset Colorectal cancer (EOCRC) incidence is increasing at an alarming pace. An increase of 90% in colon cancer and 124% in rectal cancer is expected by 2030. Patients with EOCRC are not receiving additional attention compared to older patients despite having a unique molecular pattern, majority of cases are sporadic, and related short- and long-term treatment and disease complications. The current management and screening guidelines have been constructed from studies on late onset CRC. Plethora of studies are ongoing to understand this disease entity in order to construct a tailored prevention, detection and management plans. While waiting for a better understanding of the disease, efforts should be directed toward improving the quality of care across the cancer continuum. Here we aim to address the challenges faced by EOCRC patients across the cancer continuum. This will facilitate directing future efforts and research toward construction of a personalized and precise guidelines. Studies showed that Ealy onset colorectal cancer is caused by an accumulative risk exposure. Indirect cost of premature death and reduced productivity due to EOCRC exceeds direct costs. Patients, system and physicians related diagnosis delays should be improved. Young cancer patients have unique survivorship concerns different from old patients.
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21
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Hess E, Anandan A, Osman F, Lee-Miller C, Parkes A. Disparities in Treatment Satisfaction and Supportive Care Receipt for Young Adult Oncology Patients on the Basis of Residential Location. JCO Oncol Pract 2022; 18:e1542-e1552. [DOI: 10.1200/op.21.00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Adolescent and young adult oncology programs are critical but exist primarily in academic centers, prompting potential disparities in care on the basis of patient residence. We studied the impact of residential location on supportive care receipt and treatment satisfaction in young adults (YAs) with cancer age 19-39 years treated at the University of Wisconsin Carbone Cancer Center (UWCCC). METHODS: YA patients with cancer age 19-39 years seen at UWCCC from March 30, 2019, to March 29, 2020, were sent a survey assessing supportive care receipt and satisfaction. Survey results were compared with retrospective chart review of YAs seen at UWCCC between April 1, 2011, and April 1, 2021. Data were categorized on the basis of residential location using distance from UWCCC and 2013 Rural-Urban Continuum Code (RUCC). RESULTS: Survey results were obtained for 145 YAs, including 29 from nonmetro RUCC (20.0%) and 81 living > 20 miles from UWCCC (55.9%). YAs from nonmetro locations had lower satisfaction with available treatments (79.3% v 91.4%, P = .005), and distant YAs living > 20 miles from UWCCC more frequently identified location as a barrier to supportive care receipt (35.6% v 15.8%, P = .02). Metro YAs more frequently listed fertility consultations as unavailable (38.0% v 16.0%, P = .04) in the survey despite chart review data showing higher rates of sexual health assessments (48.2% v 20.4%, P = .002) and fertility visits (29.6% v 18.5%, P = .18). CONCLUSION: We identified differences in both supportive care receipt and treatment satisfaction on the basis of residential location. These findings support the need for measures to successfully meet treatment and supportive care needs regardless of residential location.
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Affiliation(s)
- Eric Hess
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Apoorva Anandan
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Fauzia Osman
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
| | - Cathy Lee-Miller
- University of Wisconsin-Madison School of Medicine and Public Health Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplant, Madison, WI
| | - Amanda Parkes
- University of Wisconsin-Madison School of Medicine and Public Health Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care, Madison, WI
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22
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Benedict C, Dauber-Decker KL, Ford JS, King D, Spiegel D, Schapira L, Simon P, Diefenbach M. Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing. JMIR Cancer 2022; 8:e33304. [PMID: 35639461 PMCID: PMC9198824 DOI: 10.2196/33304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/26/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023] Open
Abstract
Background Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer. Objective As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience. Methods In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement. Results Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from “acceptable” in round 1 to “excellent” in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges. Conclusions Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool.
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Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | | | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, NY, United States
| | - D'Arcy King
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - David Spiegel
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Lidia Schapira
- Stanford University School of Medicine, Stanford, CA, United States.,Stanford Cancer Institute, Palo Alto, CA, United States
| | - Pamela Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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23
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Husson O, Reeve BB, Darlington AS, Cheung CK, Sodergren S, van der Graaf WTA, Salsman JM. Next Step for Global Adolescent and Young Adult Oncology: A Core Patient-Centered Outcome Set. J Natl Cancer Inst 2022; 114:496-502. [PMID: 34865066 PMCID: PMC9002284 DOI: 10.1093/jnci/djab217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/23/2021] [Indexed: 12/24/2022] Open
Abstract
The relatively small number of cancers in the adolescent and young adult (AYA) age group, those aged 15-39 years, does not appropriately reflect the personal and societal costs of cancer in this population, as reflected in the potential years of life lost or saved, the decreased productivity and health-related quality of life due to the impact of the disease during formative years, and long-term complications or disabilities. Improvements in care and outcomes for AYAs with cancer require collaboration among different stakeholders at different levels (patients, caregivers, health-care professionals, researchers, industry, and policymakers). Development of a Core Outcome Set (COS), an agreed minimum set of outcomes that should be measured globally in research and routine clinical practice-specifically for AYAs with cancer-with outcomes that are well defined based on the perspective of those who are affected and assessed with validated measures, is urgently required. A globally implemented COS for AYAs with cancer will facilitate better pooling of research data and the implementation of high-quality health-care registries, which by benchmarking not only nationally but also internationally, may ultimately improve the value of the care given to these underserved young cancer patients. We reflect on the need to develop a COS for AYAs with cancer, the arenas of application, and the challenges of implementing an age-specific COS in research and clinical practice.
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Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London, UK
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, USA
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24
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Rost M, Espeli V, Ansari M, von der Weid N, Elger BS, De Clercq E. Covid-19 and beyond: broadening horizons about social media use in oncology. A survey study with healthcare professionals caring for youth with cancer. HEALTH POLICY AND TECHNOLOGY 2022; 11:100610. [PMID: 35265457 PMCID: PMC8895679 DOI: 10.1016/j.hlpt.2022.100610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives Methods Results Conclusion
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Affiliation(s)
- Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, CH, Basel 4056, Switzerland
| | - Vittoria Espeli
- Istituto Oncologico della Svizzera Italiana, Oncologia Medica Bellinzona, TI, CH, Switzerland
| | - Marc Ansari
- Hôpitaux Universitaires de Genève Département de l'Enfant et de l'Adolescent, Onco-Hématologie Pédiatrique, CH, Genève, Switzerland
| | | | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, CH, Basel 4056, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, CH, Basel 4056, Switzerland
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25
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Ingley KM, Maleddu A, Grange FL, Gerrand C, Bleyer A, Yasmin E, Whelan J, Strauss SJ. Current approaches to management of bone sarcoma in adolescent and young adult patients. Pediatr Blood Cancer 2022; 69:e29442. [PMID: 34767314 DOI: 10.1002/pbc.29442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 01/05/2023]
Abstract
Bone tumors are a group of histologically diverse diseases that occur across all ages. Two of the commonest, osteosarcoma (OS) and Ewing sarcoma (ES), are regarded as characteristic adolescent and young adult (AYA) cancers with an incidence peak in AYAs. They are curable for some but associated with unacceptably high rates of treatment failure and morbidity. The introduction of effective new therapeutics for bone sarcomas is slow, and to date, complex biology has been insufficiently characterized to allow more rapid therapeutic exploitation. This review focuses on current standards of care, recent advances that have or may soon change that standard of care and challenges to the expert clinical research community that we suggest must be met.
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Affiliation(s)
- Katrina M Ingley
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Alessandra Maleddu
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Franel Le Grange
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Craig Gerrand
- London Sarcoma Service, Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Archie Bleyer
- Oregon Health and Science University, Portland, Oregon
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospitals NHS Trust, London, UK
| | - Jeremy Whelan
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK
| | - Sandra J Strauss
- London Sarcoma Service, University College London Hospitals NHS Trust, London, UK.,UCL Cancer Institute, London, UK
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26
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Joffe L, Steinberg DM, Strohli T, Beauchemin M. Adolescents and Young Adults with Cancer: Survivorship and Special Considerations. Pediatr Ann 2022; 51:e27-e33. [PMID: 35020510 DOI: 10.3928/19382359-20211209-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adolescents and young adults (AYAs) who have cancer face a distinct set of challenges beginning during the initial diagnosis, extending throughout treatment, and continuing into survivorship. Owing to significant strides made in cancer therapy in recent decades, more than 80% of this group will go on to become long-term survivors. Despite these improvements, however, many AYAs continue to have poorer outcomes when compared with older and younger patients. The purpose of this article is to underscore the unique set of multifaceted obstacles that this vulnerable group encounters and to pinpoint critical areas of attention and intervention throughout the health care journey. Moreover, it aims to highlight the importance of the role of the primary care provider as a constant partner in safeguarding the long-term physical and mental health of this diverse population within a complex and, at times, trying health care system. [Pediatr Ann. 2022;51(1):e27-e33.].
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27
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Unger JM, Beauchemin M, Hershman DL. Adolescent and young adult enrollment to a National Cancer Institute-sponsored National Clinical Trials Network Research Group over 25 years. Cancer 2021; 127:4574-4584. [PMID: 34351619 PMCID: PMC8665001 DOI: 10.1002/cncr.33855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adolescent and young adult (AYA) patients with cancer have not seen the same improvements in survival as younger (pediatric) patients and older patients (adults 40 years old or older). This may be related to their lower participation in clinical trials. METHODS This study examined AYA patient accrual to SWOG Cancer Research Network phase 1 to 3 clinical treatment trials for 29 cancers over 25 years (January 1996 to December 2020). Trial enrollments for AYA patients (15-39 years old) were compared with trial enrollments for older patients (40 years old or older) in SWOG and with US AYA cancer population rates derived from US Census and National Cancer Institute/Surveillance, Epidemiology, and End Results data. RESULTS In total, 84,219 patients were enrolled in SWOG treatment trials, including 7109 AYA patients (8.4%); in contrast, AYAs constituted 3.8% of the US cancer population. By histology, the highest proportions of AYA patients were in trials for Hodgkin disease (825 of 1220; 67.6%) and acute lymphocytic leukemia (350 of 678; 51.6%), whereas breast cancer trials had the greatest number of AYA patients (3032 of 32,693; 9.3%). SWOG AYA patients were more often female (68.8% vs 58.7%; P < .001), Black (10.1% vs 8.2%; P < .001), and Hispanic (10.6% vs 5.6%; P < .001) than SWOG patients who were 40 years old or older, and they were more often female (68.8% vs 65.1%; P < .001) but less often Black (10.1% vs 11.8%; P < .001) or Hispanic (10.6% vs 12.8%; P < .001) than AYA patients in the US cancer population. CONCLUSIONS AYA patients with cancer were well represented in SWOG clinical trials in comparison with US cancer population patients with the same cancers. The SWOG AYA population was more racially/ethnically diverse than older SWOG patients, although it was less diverse than the US AYA cancer population. LAY SUMMARY Adolescent and young adult (AYA) patients with cancer (aged 15-39 years) have not seen the same improvements in survival as younger (pediatric) patients and older patients (adults 40 years old or older). This may be related to their lower participation in clinical trials. This study evaluated the extent to which AYA patients were enrolled in a large, National Cancer Institute-sponsored network group over 25 years (1996-2020). Overall, 8.4% of the enrolled patients (7109 of 84,219) were AYAs; this was twice the corresponding rate of 3.8% in the US cancer population. AYA patients were also more racially/ethnically diverse than older trial patients, although they were less racially/ethnically diverse than the US AYA cancer population.
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Affiliation(s)
- Joseph M. Unger
- SWOG Statistics & Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Dawn L. Hershman
- Columbia University Mailman School of Public Health, New York, NY
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28
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Lee JA, Lim J, Jin HY, Park M, Park HJ, Park JW, Kim JH, Kang HG, Won YJ. Osteosarcoma in Adolescents and Young Adults. Cells 2021; 10:cells10102684. [PMID: 34685664 PMCID: PMC8534404 DOI: 10.3390/cells10102684] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
The epidemiology of osteosarcoma in adolescents and young adults (AYA) remains unclear. We aimed to assess and compare the clinical features of osteosarcoma between AYA and other age groups. We retrieved osteosarcoma cases diagnosed between 1999 and 2017 from the Korea Central Cancer Registry. We compared survival trends and clinical characteristics between AYA and other age groups. AYA comprised 43.3% (1309/3022) of the osteosarcoma cases. Compared to other age groups, the male-to-female ratio was highest in AYA (1.61:1). The proportion of tumors located in an extremity was 80.3% in AYA, which was lower than in young children (92.5%) or pubertal children (93.8%) but higher than in adults (55.7%) or the elderly (47.5%). As for treatments, 71.2% of AYA received local treatment and systemic chemotherapy, and 28.8% received only local treatment (surgery: 261, radiotherapy: 9, surgery and radiotherapy: 5). The 5-year overall survival (OS) was lower in AYA (68%) than in young children (78%) or pubertal children (73%) but higher than in adults (47%) or the elderly (25%). When AYA were divided into five subgroups by age, patients aged 15–19 years constituted the largest proportion (45.4%, n = 594). Additionally, the proportion of patients with a non-extremity tumor increased in an age-dependent manner, from 10.3% in AYA aged 15–19 years to 35.3% in AYA aged 35–39 years. OS did not significantly differ among the different age subgroups of AYA. The clinical characteristics and OS of the AYA were more similar to those of children than to those of adults. There is a need for cooperation between pediatric and adult oncologists for effective osteosarcoma treatment in AYA.
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Affiliation(s)
- Jun Ah Lee
- Center for Pediatric Cancer, Department of Pediatrics, Goyang 10408, Korea; (J.A.L.); (H.Y.J.); (M.P.); (H.J.P.)
| | - Jiwon Lim
- Division of Cancer Registration and Surveillance, Goyang 10408, Korea;
| | - Hye Young Jin
- Center for Pediatric Cancer, Department of Pediatrics, Goyang 10408, Korea; (J.A.L.); (H.Y.J.); (M.P.); (H.J.P.)
| | - Meerim Park
- Center for Pediatric Cancer, Department of Pediatrics, Goyang 10408, Korea; (J.A.L.); (H.Y.J.); (M.P.); (H.J.P.)
| | - Hyeon Jin Park
- Center for Pediatric Cancer, Department of Pediatrics, Goyang 10408, Korea; (J.A.L.); (H.Y.J.); (M.P.); (H.J.P.)
| | - Jong Woong Park
- Orthopedic Oncology Clinic, Center for Rare Cancer, National Cancer Center, Goyang 10408, Korea; (J.W.P.); (J.H.K.); (H.G.K.)
| | - June Hyuk Kim
- Orthopedic Oncology Clinic, Center for Rare Cancer, National Cancer Center, Goyang 10408, Korea; (J.W.P.); (J.H.K.); (H.G.K.)
| | - Hyun Guy Kang
- Orthopedic Oncology Clinic, Center for Rare Cancer, National Cancer Center, Goyang 10408, Korea; (J.W.P.); (J.H.K.); (H.G.K.)
| | - Young-Joo Won
- Division of Cancer Registration and Surveillance, Goyang 10408, Korea;
- Correspondence: ; Tel.: +82-31-920-2015
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29
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Amarin JZ, Mansour R, Nimri OF, Al-Hussaini M. Incidence of Cancer in Adolescents and Young Adults in Jordan, 2000-2017. JCO Glob Oncol 2021; 7:934-946. [PMID: 34138645 PMCID: PMC8457817 DOI: 10.1200/go.21.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The epidemiology of cancer in adolescents and young adults (AYAs) is distinct and underinvestigated. Therefore, we investigated the incidence of cancer in AYAs in Jordan.
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Affiliation(s)
- Justin Z Amarin
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Razan Mansour
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Omar F Nimri
- Jordan Cancer Registry, Ministry of Health, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
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30
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Skiba MB, Jacobs ET, Crane TE, Kopp LM, Thomson CA. Relationship Between Individual Health Beliefs and Fruit and Vegetable Intake and Physical Activity Among Cancer Survivors: Results from the Health Information National Trends Survey. J Adolesc Young Adult Oncol 2021; 11:259-267. [PMID: 34357819 DOI: 10.1089/jayao.2021.0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: The aim of this study was to describe diet and physical activity (PA) behaviors and health beliefs among cancer survivors and identify potential differences between adolescent and young adult (AYA) and adult/older cancer survivors. Methods: Cancer survivors (n = 1864) participating in the Health Information National Trends Survey (HINTS) provided responses regarding diet and PA and selected health beliefs related to general health and cancer (self-efficacy, attitudinal belief, normative belief, risk belief, intention, and self-regulation). Health belief associations with diet and PA were assessed using adjusted logistic regression models, and multiple linear regression was used for a computed Modified American Cancer Society Adherence score (0-10, higher score indicates higher adherence to recommendations); age at diagnosis was evaluated as a potential effect modifier. Results: Health behaviors between AYA and adult/older were not significantly different; a greater percent of AYA met fruit and resistance PA recommendations. Higher health self-efficacy was associated with meeting aerobic PA recommendations (odds ratio [OR]: 1.71; confidence interval [95% CI]: 1.13-2.60; p = 0.01). Higher intention was inversely related to meeting vegetable recommendation (OR: 0.58; 95% CI: 0.35-0.97; p = 0.04). Self-regulation was associated with higher odds of meeting each recommendation. Self-efficacy and self-regulation were associated with greater adherence (β = 0.52 ± 0.16, p = 0.001; β = 1.21 ± 0.24, p < 0.0001, respectively). Age at diagnosis was not an effect modifier. Conclusion: Health behaviors and beliefs among AYA and adult/older are similar. Self-efficacy and self-regulation through engagement with a mobile app support adoption of diet and PA recommendations among HINTS respondents. Future interventions should consider mechanisms to promote self-efficacy and self-regulation to maximize diet and PA behaviors in cancer survivors.
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Affiliation(s)
- Meghan B Skiba
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Tracy E Crane
- Department of Biobehavioral Sciences, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Lisa M Kopp
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Puthenpura V, Canavan ME, Poynter JN, Roth M, Pashankar FD, Jones BA, Marks AM. Racial/ethnic, socioeconomic, and geographic survival disparities in adolescents and young adults with primary central nervous system tumors. Pediatr Blood Cancer 2021; 68:e28970. [PMID: 33704901 PMCID: PMC8221084 DOI: 10.1002/pbc.28970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Disparities in survival by race/ethnicity, socioeconomic status (SES), and geography in adolescent and young adult (AYA) patients with central nervous system (CNS) tumors have not been well studied. PROCEDURE A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database was conducted for AYA patients diagnosed with primary CNS tumors. Adjusted hazard ratios (aHR) were calculated using a multivariate Cox proportional hazard model to evaluate the association between race/ethnicity, SES, rurality, and hazard of death. RESULTS All minority groups showed an increased hazard of death with greatest disparities in the high-grade glioma cohort. Lower SES was associated with an increased hazard of death in non-Hispanic White (NHW) patients (aHR 1.12; 95% confidence interval [CI] 1.01-1.24), non-Hispanic Black (NHB) patients (aHR 1.34; 95% CI 1.00-1.80), and patients aged 25-29 years (aHR 1.29; 95% CI 1.07-1.55). Mediation analysis showed an indirect effect of SES on the effect of race/ethnicity on the hazard of death only among NHB patients, with SES accounting for 33.7% of the association between NHB and hazard of death. Rurality was associated with an increased hazard of death for patients in the lowest SES tertile (aHR 1.31; 95% CI 1.08-1.59) and NHW patients (aHR 1.20; 95% CI 1.08-1.34). CONCLUSIONS Patients identified as a racial/ethnic minority, patients with a lower SES, and patients residing in rural areas had an increased hazard of death. Further studies are needed to understand and address the biological, psychosocial, societal, and economic factors that impact AYA neuro-oncology patients at highest risk of experiencing poorer outcomes.
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Affiliation(s)
- Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maureen E Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, Connecticut, USA
| | - Jenny N Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Farzana D Pashankar
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Beth A Jones
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Asher M Marks
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Wen YF, Chen MX, Yin G, Lin R, Zhong YJ, Dong QQ, Wong HM. The global, regional, and national burden of cancer among adolescents and young adults in 204 countries and territories, 1990-2019: a population-based study. J Hematol Oncol 2021; 14:89. [PMID: 34108026 PMCID: PMC8191013 DOI: 10.1186/s13045-021-01093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/19/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Accurate appraisal of burden of adolescents and young adults (AYAs) cancers is crucial to informing resource allocation and policy making. We report on the latest estimates of burden of AYA cancers in 204 countries and territories between 1990 and 2019 in association with socio-demographic index (SDI). PATIENTS AND METHODS Estimates from the Global Burden of Disease study 2019 were used to analyse incidence, mortality, and disability-adjusted life years (DALYs) due to AYA cancers at global, regional, and national levels by sex. Association between AYA cancer burden and SDI were investigated. Burdens of AYA cancers were contextualized in comparison with childhood and older adult cancers. All estimates are reported as counts and age-standardized rates per 100,000 person-years. RESULTS In 2019, there were 1.2 million incident cases, 0.4 million deaths, and 23.5 million DALYs due to AYA cancers globally. The highest age-standardized incidence rate occurred in Western Europe (75.3 [Females] and 67.4 [Males] per 100,000 person-years). Age-standardized death (23.2 [Females] and 13.9 [Males] per 100,000 person-years) and DALY (1328.3 [Females] and 1059.2 [Males] per 100,000 person-years) rates were highest in Oceania. Increasing SDI was associated with a higher age-standardized incidence rate. An inverted U-shaped association was identified between SDI and death and DALY rates. AYA cancers collectively is the second leading cause of non-communicable diseases-related deaths globally in 2019. DALYs of AYA cancers ranked the second globally and the first in low and low-middle SDI locations when compared with that of childhood and older adult cancers. CONCLUSION The global burden of AYA cancers is substantial and disproportionally affect populations in limited-resource settings. Capacity building for AYA cancers is essential in promoting equity and population health worldwide.
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Affiliation(s)
- Yi Feng Wen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Meng Xuan Chen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Guosheng Yin
- Department of Statistics and Actuarial Science, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Yu Jie Zhong
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Qian Dong
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Hai Ming Wong
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Pok Fu Lam, Hong Kong.
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McLeod KL, Skinner AM, Beaupin LK, Vadaparampil ST, Fridley BL, Reed DR. Clinical Trial Availability by Location for 1000 Simulated AYA Patients. J Adolesc Young Adult Oncol 2021; 11:95-103. [PMID: 33983850 PMCID: PMC8864422 DOI: 10.1089/jayao.2021.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) oncology patients are less likely to enroll in clinical trials than pediatric patients. After two decades of effort to improve enrollments, challenges remain. We sought to explore where phase II and phase III trials are available for an AYA cohort. Methods: Based on the epidemiology of AYA cancers and outcomes, we assembled a simulated data set of 1000 patients (AYAsims). Available phase II and phase III trials were matched to diseases and treatment setting (relapsed or newly diagnosed) and characterized by sponsor (industry, National Clinical Trials Network [NCTN], investigator initiated) and location (Moffitt Cancer Center [MCC], community or pediatric). Results: The majority of AYAsims had potential first line (64.4%) and/or relapsed (68.1%) trials. The majority of these opportunities were industry-sponsored trials available at MCC. Phase II trials for relapsed cancer were most often at the MCC and more likely to be investigator-initiated trials. Trial availability for histologies varied widely, likely reflective of the overall epidemiology of cancers beyond the AYA age range. Pediatric hospitals offered trials for select cancers but had a trial portfolio that matched the fewest number of AYAsims. Conclusions: In general, newly diagnosed AYA patients have trial enrollment opportunities in both the community and comprehensive cancer center setting with select diagnoses having more trials in pediatric hospitals. Relapsed AYA patients have the most trial opportunities at a comprehensive cancer center. A facile system that navigates patients across health systems would maximize potential AYA trial enrollments.
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Affiliation(s)
- Katie L McLeod
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Amber M Skinner
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lynda K Beaupin
- Cancer and Blood Disorder Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Brooke L Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Damon R Reed
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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Ganesan P, Jain H, Bagal B, Subramanian PG, George B, Korula A, Mehra N, Kalaiyarasi JP, Bhurani D, Agrawal N, Ahmed R, Kayal S, Bhattacharyya J, Yanamandra U, Kumar S, Philip CC, John MJ, Nadaraj A, Karunamurthy O, Lakshmanan J, Mathews V, Sengar M. Outcomes in adolescent and young adult acute lymphoblastic leukaemia: a report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 2021; 193:e1-e4. [PMID: 33656752 DOI: 10.1111/bjh.17268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Hasmukh Jain
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
| | | | - Biju George
- Department of Haematology, Christian Medical College, Vellore, India
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, India
| | - Nikita Mehra
- Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
| | | | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Smita Kayal
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jina Bhattacharyya
- Department of Clinical Hematology, Gauhati Medical College and Hospital, Gauhati, India
| | - Uday Yanamandra
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Suman Kumar
- Department of Hematology, Army Hospital (Research and Referral), New Delhi, India
| | - Chepsy C Philip
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - M Joseph John
- Department of Clinical Haematology, Christian Medical College and Hospital, Ludhiana, India
| | - Ambily Nadaraj
- Department of Biostatistics, Christian Medical College, Vellore, India
| | | | | | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, India
| | - Manju Sengar
- Department of Medical Oncology, Adult Hematolymphoid Disease Management Group, Tata Memorial Centre, Mumbai, India
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Jacobsen RL, Macpherson CF, Pflugeisen BM, Johnson RH. Care Experience, by Site of Care, for Adolescents and Young Adults With Cancer. JCO Oncol Pract 2021; 17:e817-e826. [PMID: 33566700 DOI: 10.1200/op.20.00840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Most of the 77,000 adolescents and young adults (AYAs) 15-39 years of age diagnosed with cancer annually in the United States are treated at community rather than academic centers. Little is known about their healthcare experience. METHODS A cross-sectional, anonymous, online survey was conducted with a convenience sample of AYAs treated for cancer at US academic (n = 112) or community centers (n = 64). RESULTS Clinical trials were offered more frequently to respondents treated at academic centers (26.8% v 7.8%; P = .005). Eighty percent of all those offered a clinical trial chose to enroll. Over three-fourths reported awareness of community-based or online AYA oncology support services; however, significantly more respondents from academic centers reported awareness of services provided by the institution itself (40.2% v 7.8%; P < .001). Significantly more respondents from academic centers reported receiving information relevant to their age group (41.1% v 15.6%; P < .001). Respondents treated at academic centers were significantly more satisfied with support, communication, and overall treatment. Odds of respondents treated at an academic center reporting that their healthcare team knew enough about AYAs were 3.12-fold higher than those treated at community centers (95% CI, 1.6 to 6.4; P = .002). Odds of overall satisfaction were significantly higher for respondents who reported that their healthcare team "knew enough about AYAs" (aOR, 9.7, 95% CI, 2.4 to 53.9; P = .003). CONCLUSION Cancer treatment for AYAs at both academic and community centers can be optimized by improving healthcare providers' understanding of the key issues facing AYAs with cancer and by increasing AYA-specific institutional resources and support services.
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Husson O, Sodergren SC, Darlington AS. The importance of a collaborative health-related quality of life measurement strategy for adolescents and young adults with cancer. Cancer 2021; 127:1712-1713. [PMID: 33496340 DOI: 10.1002/cncr.33416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/02/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Samantha C Sodergren
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne-Sophie Darlington
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
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37
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Gingrich AA, Sauder CAM, Goldfarb M, Li Q, Wun T, Keegan THM. Disparities in the Occurrence of Late Effects following Treatment among Adolescent and Young Adult Melanoma Survivors. Cancer Epidemiol Biomarkers Prev 2020; 29:2195-2202. [PMID: 32856613 PMCID: PMC7641994 DOI: 10.1158/1055-9965.epi-20-0427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/05/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Melanoma is the third most common cancer in the adolescent and young adult (AYA) population; however, no studies have addressed the occurrence of adverse health conditions following melanoma treatment in these survivors. METHODS Data for patients ages 15 to 39 years diagnosed with cutaneous melanoma from 1996 to 2012 and surviving ≥2 years were obtained from the California Cancer Registry and linked to statewide hospitalization data. The influence of age at diagnosis, sex, race/ethnicity, neighborhood socioeconomic status (SES), health insurance, and surgery on the development of adverse health conditions was evaluated using Cox proportional hazards regression models. RESULTS Of 8,259 patients, 35.3% were male, 83.3% were non-Hispanic White, 82.4% had private health insurance, and 60.5% were considered high SES. In Cox regression models, males had an increased risk of developing adverse health conditions across all systems, including cardiac [HR, 1.73, 95% confidence interval (CI), 1.47-2.03], lymphedema (HR, 1.56; 95% CI, 1.37-1.77), hematologic disorders (HR, 1.17; 95% CI, 1.03-1.33), major infection/sepsis (HR, 1.59; 95% CI, 1.39-1.82), and second cancers (HR, 1.51; 95% CI, 1.31-1.74). Patients with public/no insurance (vs. private) had a greater risk of developing all studied adverse health conditions, including subsequent cancers (HR, 2.34; 95% CI, 1.94-2.82). AYA patients residing in low SES neighborhoods had similar increased risk of developing adverse health conditions. CONCLUSIONS Of AYA melanoma survivors, males, those with public/no health insurance, and those living in low SES neighborhoods had a greater likelihood of developing adverse health conditions. IMPACT Strategies to improve surveillance and secondary prevention of these adverse health conditions are needed among AYA melanoma survivors, specifically for the at-risk populations identified.
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Affiliation(s)
- Alicia A Gingrich
- Department of Surgery, University of California, Davis, Sacramento, California.
| | - Candice A M Sauder
- Comprehensive Cancer Center, University of California, Davis, Sacramento, California
| | - Melanie Goldfarb
- Center for Endocrine Tumors and Disorders, John Wayne Cancer Institute, Santa Monica, California
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, California
| | - Ted Wun
- Comprehensive Cancer Center, University of California, Davis, Sacramento, California
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, California
| | - Theresa H M Keegan
- Comprehensive Cancer Center, University of California, Davis, Sacramento, California
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, California
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38
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Long term toxicity of intracranial germ cell tumor treatment in adolescents and young adults. J Neurooncol 2020; 149:523-532. [PMID: 33034840 DOI: 10.1007/s11060-020-03642-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to describe the long-term toxicities of intracranial germ cell tumor (IGCT) in the adolescent and young adult (AYA) population. METHODS We report late toxicities of a multi-center cohort of AYA patients treated for IGCT between 1975 and 2015. Charts were retrospectively reviewed for hormone deficiency, ototoxicity, seizure disorder, visual deterioration, cerebrovascular events, second neoplasm, psychiatric illness, and neurocognitive impairment. Statistical analysis was performed for late toxicities to evaluate the influence of select factors. RESULTS Our patient cohort included 112 patients with IGCTs; 84% of patients had a germinoma as opposed to a non-germinomatous germ cell tumor (NGGCT), median age at radiotherapy (RT) was 19 years, and median follow-up was 8.3 years. Of the 94 patients with germinoma, 32 (34%) received both chemotherapy and RT as part of their upfront treatment, while 62 (66%) received RT alone. All 18 patients with NGGCT received chemotherapy and RT. The most common late toxicity following IGCT treatments was physician-reported neurocognitive impairment, with a 10-year cumulative incidence (CI) of 38.5%. Ten-year CI of treatment-induced ototoxicity was 39.2% for patients who received cisplatin, compared to 3.6% for those who received carboplatin but no cisplatin (p < 0.005). Suprasellar/hypothalamic tumor location was associated with 10-year CI of treatment-induced hormone deficiency (36.1 vs 6.2%, p < 0.005). CONCLUSIONS A significant proportion of AYAs treated for IGCTs experience late effects from treatment, including neurocognitive impairment, ototoxicity, and hormone deficiency. Suprasellar/hypothalamic tumor location and cisplatin were associated with a higher risk of treatment-induced hormone deficiency and ototoxicity, respectively.
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De Clercq E, Rost M, Gumy-Pause F, Diesch T, Espeli V, Elger BS. Moving Beyond the Friend-Foe Myth: A Scoping Review of the Use of Social Media in Adolescent and Young Adult Oncology. J Adolesc Young Adult Oncol 2020; 9:561-571. [DOI: 10.1089/jayao.2019.0168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Fabienne Gumy-Pause
- Département de l'Enfant et de l'Adolescent, Onco-hématologie pédiatrique, Hôpitaux Universitaires de Genève, Geneve, Switzerland
| | - Tamara Diesch
- Onkologie/Hämatologie, Universitäts-Kinderspital Basel, Basel, Switzerland
| | - Vittoria Espeli
- Oncologia medica, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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40
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Wang X, Ojha RP, Partap S, Johnson KJ. The effect of insurance status on overall survival among children and adolescents with cancer. Int J Epidemiol 2020; 49:1366-1377. [DOI: 10.1093/ije/dyaa079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
Background
Differences in access, delivery and utilisation of health care may impact childhood and adolescent cancer survival. We evaluated whether insurance coverage impacts survival among US children and adolescents with cancer diagnoses, overall and by age group, and explored potential mechanisms.
Methods
Data from 58 421 children (aged ≤14 years) and adolescents (15–19 years), diagnosed with cancer from 2004 to 2010, were obtained from the National Cancer Database. We examined associations between insurance status at initial diagnosis or treatment and diagnosis stage; any treatment received; and mortality using logistic regression, Cox proportional hazards (PH) regression, restricted mean survival time (RMST) and mediation analyses.
Results
Relative to privately insured individuals, the hazard of death (all-cause) was increased and survival months were decreased in those with Medicaid [hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.22 to 1.33; and −1.73 months, 95% CI: −2.07 to −1.38] and no insurance (HR = 1.32, 95% CI: 1.20 to 1.46; and −2.13 months, 95% CI: −2.91 to −1.34). The HR for Medicaid vs. private insurance was larger (pinteraction <0.001) in adolescents (HR = 1.52, 95% CI: 1.41 to 1.64) than children (HR = 1.16, 95% CI: 1.10 to 1.23). Despite statistical evidence of PH assumption violation, RMST results supported all interpretations. Earlier diagnosis for staged cancers in the Medicaid and uninsured populations accounted for an estimated 13% and 19% of the survival deficit, respectively, vs. the privately insured population. Any treatment received did not account for insurance-associated survival differences in children and adolescents with cancer.
Conclusions
Children and adolescents without private insurance had a higher risk of death and shorter survival within 5 years following cancer diagnosis. Additional research is needed to understand underlying mechanisms.
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Affiliation(s)
- Xiaoyan Wang
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Rohit P Ojha
- Center for Outcomes Research, JPS Health Network, Fort Worth, TX, USA
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sonia Partap
- Department of Neurology, Stanford University, Palo Alto, CA, USA
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Kimberly J Johnson
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
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Ou JY, Hanson HA, Ramsay JM, Kaddas HK, Pope CA, Leiser CL, VanDerslice J, Kirchhoff AC. Fine Particulate Matter Air Pollution and Mortality among Pediatric, Adolescent, and Young Adult Cancer Patients. Cancer Epidemiol Biomarkers Prev 2020; 29:1929-1939. [PMID: 32404444 DOI: 10.1158/1055-9965.epi-19-1363] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/28/2020] [Accepted: 03/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Air pollution is a carcinogen and causes pulmonary and cardiac complications. We examined the association of fine particulate matter pollution (PM2.5) and mortality from cancer and all causes among pediatric, adolescent, and young adult (AYA) patients with cancer in Utah, a state with considerable variation in PM2.5. METHODS We followed 2,444 pediatric (diagnosed ages 0-14) and 13,459 AYA (diagnosed ages 15-39) patients diagnosed in 1986-2015 from diagnosis to 5 and 10 years postdiagnosis, death, or emigration. We measured average monthly PM2.5 by ZIP code during follow-up. Separate pediatric and AYA multivariable Cox models estimated the association of PM2.5 and mortality. Among AYAs, we examined effect modification of PM2.5 and mortality by stage while controlling for cancer type. RESULTS Increases in PM2.5 per 5 μg/m3 were associated with cancer mortality in pediatric lymphomas and central nervous system (CNS) tumors at both time points, and all cause mortality in lymphoid leukemias [HR5-year = 1.32 (1.02-1.71)]. Among AYAs, PM2.5 per 5 μg/m3 was associated with cancer mortality in CNS tumors and carcinomas at both time points, and all cause mortality for all AYA cancer types [HR5-year = 1.06 (1.01-1.13)]. PM2.5 ≥12 μg/m3 was associated with cancer mortality among breast [HR5-year = 1.50 (1.29-1.74); HR10-year = 1.30 (1.13-1.50)] and colorectal cancers [HR5-year = 1.74 (1.29-2.35); HR10-year = 1.67 (1.20-2.31)] at both time points. Effect modification by stage was significant, with local tumors at highest risk. CONCLUSIONS PM2.5 was associated with mortality in pediatric and AYA patients with specific cancers. IMPACT Limiting PM2.5 exposure may be important for young cancer patients with certain cancers.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."
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Affiliation(s)
- Judy Y Ou
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah.
| | - Heidi A Hanson
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joemy M Ramsay
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah
| | - Heydon K Kaddas
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah
| | | | - Claire L Leiser
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - James VanDerslice
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, Utah
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Morrison-Smith CD, Knox TM, Filic I, Soroko KM, Eschle BK, Wilkens MK, Gokhale PC, Giles F, Griffin A, Brown B, Shapiro GI, Zucconi BE, Cole PA, Lemieux ME, French CA. Combined Targeting of the BRD4-NUT-p300 Axis in NUT Midline Carcinoma by Dual Selective Bromodomain Inhibitor, NEO2734. Mol Cancer Ther 2020; 19:1406-1414. [PMID: 32371576 DOI: 10.1158/1535-7163.mct-20-0087] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/12/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022]
Abstract
NUT midline carcinoma (NMC) is a rare, aggressive subtype of squamous carcinoma that is driven by the BRD4-NUT fusion oncoprotein. BRD4, a BET protein, binds to chromatin through its two bromodomains, and NUT recruits the p300 histone acetyltransferse (HAT) to activate transcription of oncogenic target genes. BET-selective bromodomain inhibitors have demonstrated on-target activity in patients with NMC, but with limited efficacy. P300, like BRD4, contains a bromodomain. We show that combining selective p300/CBP and BET bromodomain inhibitors, GNE-781 and OTX015, respectively, induces cooperative depletion of MYC and synergistic inhibition of NMC growth. Treatment of NMC cells with the novel dual p300/CBP and BET bromodomain-selective inhibitor, NEO2734, potently inhibits growth and induces differentiation of NMC cells in vitro; findings that correspond with potentiated transcriptional effects from combined BET and p300 bromodomain inhibition. In three disseminated NMC xenograft models, NEO2734 provided greater growth inhibition, with tumor regression and significant survival benefit seen in two of three models, compared with a lead clinical BET inhibitor or "standard" chemotherapy. Our findings provide a strong rationale for clinical study of NEO2734 in patients with NMC. Moreover, the synergistic inhibition of NMC growth by CBP/p300 and BET bromodomain inhibition lays the groundwork for greater mechanistic understanding of the interplay between p300 and BRD4-NUT that drives this cancer.
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Affiliation(s)
- Chevaun D Morrison-Smith
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tatiana M Knox
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ivona Filic
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara M Soroko
- Experimental Therapeutics Core and Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Benjamin K Eschle
- Experimental Therapeutics Core and Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Margaret K Wilkens
- Experimental Therapeutics Core and Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Prafulla C Gokhale
- Experimental Therapeutics Core and Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Francis Giles
- Developmental Therapeutics Consortium, Chicago, Ilinois
| | | | - Bill Brown
- Paraza Pharma Inc., Montreal, Quebec, Canada
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Beth E Zucconi
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital and Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | - Philip A Cole
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital and Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts
| | | | - Christopher A French
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Lokeshwar SD, Patel P, Fantus RJ, Halpern J, Chang C, Kargi AY, Ramasamy R. Decline in Serum Testosterone Levels Among Adolescent and Young Adult Men in the USA. Eur Urol Focus 2020; 7:886-889. [PMID: 32081788 DOI: 10.1016/j.euf.2020.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/11/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Testosterone deficiency has a prevalence of 20% among adolescent and young adult (AYA) males. Although previous studies have shown that total testosterone (TT) levels are declining in the population compared to prior decades, no study has identified TT level trends for AYA males specifically. Using data from the National Health and Nutrition Examination Surveys, we investigated TT levels for 4045 men from 1999 to 2016. After controlling for confounders, we found that mean TT levels declined over time: TT levels were lower in the later (2011-2016) than in the earlier (1999-2000) cycles (all p < 0.001). Elevated body mass index (BMI) was associated with lower TT, but the trend remained significant even among men with normal BMI. Limitations include the influence of confounding variables such as environmental factors and the use of differing assays for TT measurement. Further studies using other data streams are needed to validate these findings. PATIENT SUMMARY: In this report we looked at data for adolescent and young adult men in a US national database on total testosterone (TT) levels. There has been a decline in mean TT levels over the past two decades and TT is lower with progressively higher body mass index. We conclude that TT levels have been declining in young adult men in recent decades.
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Affiliation(s)
| | | | - Richard J Fantus
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua Halpern
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cecilia Chang
- NorthShore University Health System, Chicago, IL, USA
| | - Atil Y Kargi
- University of Miami Miller School of Medicine, Miami, FL, USA
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The Role of Social Support in Adolescent/Young Adults Coping with Cancer Treatment. CHILDREN-BASEL 2019; 7:children7010002. [PMID: 31877952 PMCID: PMC7022818 DOI: 10.3390/children7010002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
Adolescents/young-adult (AYA) cancer patients are a psychosocially at-risk group as they are often less well-studied than other age cancer cohorts. Therefore, they experience disparities in access to developmentally informed treatment. Social support has been determined as an important aspect of AYAs’ cancer experience, but additional research was needed to describe specific behaviors AYAs found helpful and to explore how AYAs seek opportunities for additional support. As part of a larger qualitative study, study aims were to determine how AYAs (ages 15–26) cope during cancer treatment and examine how social support interacts with individual AYA coping. Participants included 10 AYA cancer patients undergoing treatment (mean age = 18.9 years) and 10 parents (mean age = 45.6 years). Descriptively, participants scored within the normal to high range on measures of hope, depression/anxiety/stress, quality of life, and social support. Participants completed semi-structured, audio-recorded interviews that were transcribed and coded as generated. Qualitative analysis was guided by principles of grounded theory and utilized the constant comparative approach. Themes within social support groups included presence, distraction, positive attitude, and maintaining AYA autonomy, communication, and advocacy. Results suggest social supports provide additional coping resources for AYAs with cancer through supplementing individual coping strategies. Future directions/implications for intervention/treatment are discussed.
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Abstract
PURPOSE OF REVIEW Effective transitional care for adolescents and young adults (AYA) with rheumatic musculoskeletal disease (RMD) is fundamental to rheumatology care provision. Here we review the recent evidence from the literature on transition in rheumatology and debate why universal implementation has yet to be recognised. RECENT FINDINGS Evidence of need for transitional care continues to be reported. The triphasic nature of transitional care remains poorly recognised, and the third phase following transfer to adult rheumatology is particularly under-researched in spite of the recognition of the age-related trajectories of transition skill development during young adulthood. Several rheumatology-specific transitional care interventions have now been evaluated but the search for valid measures including outcome continues. Finally, the need to study transition at a health system level is increasingly recognised. Future research in this area should consider the developmental trajectories of AYA as well as the social-ecological model of transition readiness, which focuses on the interactions between AYA, caregivers and providers (and the systems they are part of) as these are the likely targets of any intervention to improve health transitions.
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Affiliation(s)
- Janet E McDonagh
- Versus Arthritis Centre for Epidemiology, Centre for MSK Research, University of Manchester and NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK.
| | - Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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