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Knoerl R, Grandinetti K, Smener L, Doll E, Fecher LA, Henry NL, Karimi Y, Pettit K, Schuetze S, Walling E, Zhang A, Barton D. Exploring Adolescent and Young Adult Cancer Survivors' Experience with Cancer Treatment-Related Symptoms: A Qualitative Analysis of Semi-Structured Interviews. J Adolesc Young Adult Oncol 2024; 13:665-673. [PMID: 38634665 PMCID: PMC11322622 DOI: 10.1089/jayao.2024.0053] [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] [Indexed: 04/19/2024] Open
Abstract
Purpose: Few studies have specifically targeted symptom management interventions for adolescent and young adult (AYA) cancer survivors. A greater understanding of AYA cancer survivors' experiences with cancer treatment-related symptoms would help develop age-appropriate oncology symptom management interventions. The purpose of this qualitative analysis was to explore AYA cancer survivors' experience with cancer treatment-related symptoms. Methods: Nineteen post-treatment AYA cancer survivors (18-39 years old) who self-reported moderate-severe cancer treatment-related symptom severity participated in video conferencing or telephone interviews. The questions in the interview guide queried participants to share their experience with cancer treatment-related symptoms. Inductive content analysis was used to identify themes from the interviews. Results: The themes that emerged from the interviews included (1) cancer treatment-related symptoms negatively affected AYA cancer survivors' quality of life (e.g., symptoms served as a reminder of cancer recurrence possibility); (2) AYA cancer survivors' attitudes and feelings about communicating cancer treatment-related symptom concerns to clinicians (e.g., patient-clinician communication was bolstered when AYAs perceived that symptoms were being taken seriously); (3) AYA cancer survivors are interested in oncology symptom management clinical trials, but logistical challenges are barriers to participation; and (4) AYA cancer survivors are interested in nonpharmacological treatments for symptom management. Conclusion: Results highlight the burden of cancer treatment-related symptoms on day-to-day life among post-treatment AYA cancer survivors. Future work is needed to identify nonpharmacological symptom management interventions, strategies to improve patient-clinician communication about symptoms, and strategies to increase the visibility and accessibility of symptom management clinical trials for AYA cancer survivors.
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Affiliation(s)
- Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | - Liat Smener
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Doll
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Leslie A. Fecher
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - N. Lynn Henry
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Yasmin Karimi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristen Pettit
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott Schuetze
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Debra Barton
- College of Nursing, The University of Tennessee, Knoxville, Tennessee, USA
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2
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Siegel DA, Durbin EB, Pollock BH, Grimes A, Ji L, Alonzo TA, Vargas SL, Huang B, McDowell JR, Lycan E, Ransdell P, Tai E, Roth ME, Freyer DR. Population-Based Data Linkage Describing Patterns of Cancer Clinical Trial Enrollment Among Children and Adolescents. JCO Oncol Pract 2024; 20:631-642. [PMID: 38194612 PMCID: PMC11090697 DOI: 10.1200/op.23.00325] [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: 05/30/2023] [Revised: 10/02/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Database linkage between cancer registries and clinical trial consortia has the potential to elucidate referral patterns of children and adolescents with newly diagnosed cancer, including enrollment into cancer clinical trials. This study's primary objective was to assess the feasibility of this linkage approach. METHODS Patients younger than 20 years diagnosed with incident cancer during 2012-2017 in the Kentucky Cancer Registry (KCR) were linked with patients enrolled in a Children's Oncology Group (COG) study. Matched patients between databases were described by sex, age, race and ethnicity, geographical location when diagnosed, and cancer type. Logistic regression modeling identified factors associated with COG study enrollment. Timeliness of patient identification by KCR was reported through the Centers for Disease Control and Prevention's Early Case Capture (ECC) program. RESULTS Of 1,357 patients reported to KCR, 47% were determined by matching to be enrolled in a COG study. Patients had greater odds of enrollment if they were age 0-4 years (v 15-19 years), reported from a COG-affiliated institution, and had renal cancer, neuroblastoma, or leukemia. Patients had lower odds of enrollment if Hispanic (v non-Hispanic White) or had epithelial (eg, thyroid, melanoma) cancer. Most (59%) patients were reported to KCR within 10 days of pathologic diagnosis. CONCLUSION Linkage of clinical trial data with cancer registries is a feasible approach for tracking patient referral and clinical trial enrollment patterns. Adolescents had lower enrollment compared with younger age groups, independent of cancer type. Population-based early case capture could guide interventions designed to increase cancer clinical trial enrollment.
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Affiliation(s)
- David A. Siegel
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric B. Durbin
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Brad H. Pollock
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Allison Grimes
- University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Lingyun Ji
- Children’s Oncology Group, Monrovia, CA
- University of Southern California, Los Angeles, CA
| | - Todd A. Alonzo
- Children’s Oncology Group, Monrovia, CA
- University of Southern California, Los Angeles, CA
| | | | - Bin Huang
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Jaclyn R. McDowell
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Ellen Lycan
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Peter Ransdell
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Eric Tai
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David R. Freyer
- University of Southern California, Los Angeles, CA
- Children’s Hospital Los Angeles, Los Angeles, CA
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3
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Wyatt KD, Volchenboum SL. Targeted Enrollment in Pediatric Oncology Trials: A Vision for Just-in-Time Matching. JCO Oncol Pract 2024; 20:603-606. [PMID: 38386948 DOI: 10.1200/op.23.00826] [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: 12/26/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024] Open
Abstract
@PedsDataCommons shares vision for automated clinical trials matching in pediatric oncology.
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Affiliation(s)
- Kirk D Wyatt
- Department of Pediatric Hematology/Oncology, Roger Maris Cancer Center, Fargo, ND
- Data for the Common Good, University of Chicago, Chicago, IL
| | - Samuel L Volchenboum
- Data for the Common Good, University of Chicago, Chicago, IL
- Department of Pediatrics, University of Chicago, Chicago, IL
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4
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Scott I, Oberoi S. Developing an Adolescent and Young Adult Oncology Program in a Medium-Sized Canadian Centre: Lessons Learned. Curr Oncol 2024; 31:2420-2426. [PMID: 38785462 PMCID: PMC11119119 DOI: 10.3390/curroncol31050181] [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: 03/26/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The Adolescent and Young Adult (AYA) Program at CancerCare Manitoba (CCMB) has experienced tremendous growth since its inception. This report provides an overview of how the AYA program at CCMB was established and the crucial factors that led to its early accomplishments and continued expansion. These factors included actions and decisions made at the individual and organizational level that helped lay a strong foundation for the program's sustained success. We hope that some of these lessons learned can be adapted and implemented by other oncology agencies to improve the care outcomes and experiences of AYAs living with cancer.
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Affiliation(s)
- Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Sapna Oberoi
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R2H 2A6, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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5
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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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6
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Wu J, Heidelberg RE, Gajjar A. Adolescents and Young Adults With Cancer: CNS Tumors. J Clin Oncol 2024; 42:686-695. [PMID: 38064656 DOI: 10.1200/jco.23.01747] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 02/16/2024] Open
Abstract
Tumors of CNS are common in adolescents and young adults (AYAs). As the second leading cause of cancer-related death, CNS tumors in AYAs require improved clinical management. In this review, we discussed the current diagnostic approaches and recommended management strategies for malignant tumors in adult-type (IDH-mutant gliomas) and pediatric-type gliomas (pediatric high-grade gliomas), ependymoma and medulloblastoma, which commonly occur in AYAs. The impact of advanced molecular diagnostic approaches on the understanding of tumor biology of AYA CNS tumors is emphasized. To enhance participation in clinical trials, which poses a unique challenge in AYAs with CNS tumors, we propose encouraging referrals to neuro-oncology specialty care and improving collaboration between oncologists who care for both pediatric and adult patients. This will ensure better representation of AYA patients in research studies. Finally, we discussed the importance of considering neurocognitive and psychological function in AYAs with CNS tumor.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - R Elyse Heidelberg
- Department of Psychology & Biobehavioral Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Amar Gajjar
- Division of Neuro-Oncology, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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7
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Byrne EM, Pascoe M, Cooper D, Armstrong TS, Gilbert MR. Challenges and limitations of clinical trials in the adolescent and young adult CNS cancer population: A systematic review. Neurooncol Adv 2024; 6:vdad159. [PMID: 38250563 PMCID: PMC10798804 DOI: 10.1093/noajnl/vdad159] [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] [Indexed: 01/23/2024] Open
Abstract
Background The adolescent and young adult (AYA) cancer population, aged 15-39, carries significant morbidity and mortality. Despite growing recognition of unique challenges with this age group, there has been little documentation of unmet needs in their care, trial participation, and quality of life, particularly in those with primary brain tumors. Methods A systematic literature review of 4 databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies included editorials, reviews, and practice guidelines on the challenges and limitations faced by the AYA population. Papers had to address CNS tumors. Results Sixty-eight studies met the inclusion criteria. The challenges and limitations in clinical trials in the AYA population were synthesized into 11 categories: molecular heterogeneity, tumor biology, diagnostic delay, access to care, physician factors, patient factors, primary brain tumor (PBT) factors, accrual, limited trials, long term follow up, and trial design. The published papers' recommendations were categorized based on the target of the recommendation: providers, coordination of care, organizations, accrual, and trial design. The AYA cancer population was found to suffer from unique challenges and barriers to care and the construction of trials. Conclusions The AYA CNS cancer population suffers from unique challenges and barriers to care and construction of trials that make it critical to acknowledge AYAs as a distinct patient population. In addition, AYAs with primary brain tumors are underrecognized and underreported in current literature. More studies in the AYA primary brain tumor patient population are needed to improve their care and participation in trials.
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Affiliation(s)
- Emma M Byrne
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Maeve Pascoe
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Diane Cooper
- National Institute of Health Library, National Institute of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
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8
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Burgers VWG, Reuvers MJP, Taphoorn MJB, Kok M, de Langen AJ, van den Bent MJ, Frissen SAMM, Harthoorn NCGL, Dickhout A, Husson O, van der Graaf WTA. A qualitative study on the healthcare experiences of adolescents and young adults (AYA) with an uncertain or poor cancer prognosis. Support Care Cancer 2023; 31:721. [PMID: 38008874 DOI: 10.1007/s00520-023-08149-9] [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: 04/24/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Treatment advancements have improved life expectancy for adolescents and young adults (AYAs) with an uncertain and/or poor cancer prognosis (UPCP) and change clinical practice. This improved survival requires a different approach and specific expertise to meet the needs of this group. The aim of this study is to explore the health care experiences of AYAs with a UPCP. METHODS We conducted a multicenter qualitative study using semi-structured interviews and elements of the grounded theory by Corbin and Strauss. RESULTS Interviews were conducted with 46 AYAs with a UPCP. They were on average 33.4 years old (age range 23-44), and most of them were woman (63%). Additionally, five AYAs with a UPCP participated as AYA research partners in two focus groups. They were on average 31.8 years old and four of them were woman. AYAs with a UPCP reported four pillars for a satisfied healthcare experience: (1) trust, (2) tailored communication, (3) holistic empathic open attitude, and (4) care being offered (pro-)actively. They reported both optimal and suboptimal experiences about distrust based on a delay in diagnostic trajectory, lack of tailored communication and discussion of sensitive topics, preference for a holistic approach, and struggles with finding the way to get additional healthcare support. CONCLUSION For AYAs with a UPCP, it is important that both age-specific issues and issues related to the UPCP are understood and addressed; however, this seems not yet optimally implemented in clinical practice. This emphasizes the importance of providing this patient group with tailored care incorporating both aspects. Healthcare professionals need to be supported with training and tools to understand the healthcare needs of AYAs with a UPCP. AYAs can be empowered to take more control over their own healthcare needs.
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Affiliation(s)
- Vivian W G Burgers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Milou J P Reuvers
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Tumor Biology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Adrianus J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Annemiek Dickhout
- AYA Research Partner, Amsterdam, the Netherlands
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW-School of Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Olga Husson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
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9
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Wayant C, Fitzgerald K, Hemmerich C, Geng Y, Freyer D, Roth M. Prevalence of Adverse Event Reporting in Adolescents and Young Adults Enrolled in Cancer Clinical Trials. JCO Oncol Pract 2023; 19:1048-1052. [PMID: 37748116 PMCID: PMC10667017 DOI: 10.1200/op.23.00201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/04/2023] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE Survival for adolescents and young adults (AYAs) with cancer has improved over the past few decades, and targeted approaches are needed to further improve outcomes. Limited reports suggest that AYAs tolerate cancer treatment differently than older and younger patients. Lack of adverse event (AE) data prevents the optimization of treatment regimens for AYAs by maximizing drug delivery and minimizing treatment-related toxicity. The extent to which the frequency and severity of AEs are reported for AYAs in cancer trials is unknown. METHODS Using a retrospective, observational design we reviewed all phase II/III clinical trials published in 2021 that included cancer-directed therapy and enrolled at least one patient age 15-39 years diagnosed with one of the five common AYA cancers: breast cancer, colorectal cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, or melanoma. The primary outcome was to determine the proportion of phase II/III trials that report AEs for the AYA population. RESULTS Of 2,540 publications identified, 182 were included in the final analysis. No studies reported AE data for AYAs separate from older adults. Given the lack of reporting of AEs by age, it was not possible to assess differences in AE frequency or severity or whether AEs were associated with differences in dose reductions, treatment delays, or discontinuation for AYAs. CONCLUSION Reporting of AEs for AYAs with cancer is absent in the public domain. Failure to account for differences in treatment tolerance between AYAs and older adults may lead to undertreatment or overtreatment and delay progress toward further improving outcomes for AYAs.
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Affiliation(s)
- Cole Wayant
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Kyle Fitzgerald
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Christian Hemmerich
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Yimin Geng
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
- Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Phillips CS, Bockhoff J, Berry DL, Buchbinder E, Frazier AL, LaCasce A, Ligibel J, Luskin MR, Woods H, Knoerl R. Exploring Young Adults' Perspectives of Participation in a Mindfulness-Based Music Therapy Intervention Before and During the COVID-19 Pandemic. J Adolesc Young Adult Oncol 2023; 12:569-576. [PMID: 36752714 DOI: 10.1089/jayao.2022.0090] [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] [Indexed: 02/09/2023] Open
Abstract
Purpose: To explore adolescent and young adults' (AYAs) experiences with participation in a mindfulness-based music therapy intervention during cancer treatment before and during the COVID-19 pandemic. Methods: Sixteen young adults (20-39 years old) who received cancer treatment and participated in a mindfulness-based music therapy intervention for anxiety and stress were interviewed using a semistructured interview guide. Interviews were audio recorded and transcribed verbatim. The interview guide contained prompts about reasons for joining the study, usual coping strategies, experience with the in-person and virtual delivery formats of the intervention, and suggestions for improvement. Themes were derived from the data using inductive content analysis methods. Results: Findings from the interviews included the following: (1) virtual group participants reported difficulty finding a private place to attend the intervention sessions, (2) participants experienced a sense of relaxation in response to intervention participation, (3) in-person group participants felt a sense of connection to the music and their family members who were present during the intervention, while virtual group participants felt a sense of connection to mindfulness, (4) virtual group participants reported that practicing music and mindfulness together was synergistic, and (5) in-person intervention delivery was preferred to virtual intervention delivery. Conclusion: This study provides insight into the contextual factors that impact satisfaction with the intervention and the effect of the intervention on anxiety and stress. Overall, while virtual mindfulness-based music therapy delivery may be more feasible, there are still important advantages to in-person delivery that should be considered in the design of future mindfulness-based music therapy interventions. ClinicalTrials.gov Identifier: NCT03709225.
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Affiliation(s)
- Carolyn S Phillips
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julianna Bockhoff
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
| | - Elizabeth Buchbinder
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - A Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Heather Woods
- The Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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11
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Mobley EM, Thomas SM, Brailsford J, Ochoa CY, Miller K, Applebaum A, Milam J, Freyer DR. Clinical Trial Participation: A Qualitative Study of Adolescents and Younger Adults Recently Diagnosed with Cancer. J Adolesc Young Adult Oncol 2023; 12:303-313. [PMID: 35900287 PMCID: PMC10282798 DOI: 10.1089/jayao.2022.0050] [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: 11/12/2022] Open
Abstract
Purpose: Although participation of adolescents and young adults (AYAs) in cancer clinical trials (CCTs, i.e., cancer-directed treatment studies) is low, their decision-making perspectives are not well understood, especially following recent diagnosis. Methods: Semistructured interviews with younger AYAs (15-21 years old) eligible for a CCT were to be held within 60 days of beginning treatment at Children's Hospital Los Angeles, an academic pediatric hospital. Using grounded theory methods, key themes regarding CCT participation, barriers, and facilitators were identified from interview transcripts. Thematic saturation was confirmed. Results: Of nine participants, three were <18 years old, four Hispanic, six male, six diagnosed with leukemia, eight enrolled in a CCT, and eight also enrolled in ancillary studies. Four overarching themes emerged: (1) Initial Consent encompassed the first discussion of CCT with patients reflecting positive and negative effects of timing, decisional role, and the emotional impact following cancer diagnosis; (2) Informing Participation involved decision-making processes, specific knowledge, comprehension, and external influences; (3) Participant Relationships emphasized the importance of communication and relationships with providers and parents; and (4) Patient Determinants centered on motives from different perspectives, pre-conceived attitudes, and understanding of CCTs. Conclusion: Recommendations for improving CCT participation among younger AYAs include separating the diagnosis/treatment and CCT discussions, assigning AYAs a meaningful decisional role, having ongoing provider conversations, designing trials to minimize burden, and developing age-appropriate decision aids.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Stefanie M. Thomas
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Jennifer Brailsford
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Carol Y. Ochoa
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anise Applebaum
- College of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, University of California Irvine, Irvine, California, USA
| | - David R. Freyer
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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12
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Keim-Malpass J, Callahan LB, Lindley LC, Templeman CA, Mooney-Doyle K. Perspectives on Access to Novel Therapeutics Through Clinical Trials Among Adolescents and Young Adults with Advanced Cancer: Implications for Patient-Centered Clinical Trials. J Adolesc Young Adult Oncol 2023; 12:53-58. [PMID: 35235445 DOI: 10.1089/jayao.2021.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYA) with advanced cancer have unequal access to and enrollment in clinical trials. Many AYA use online platforms to share their treatment experiences. The purpose of this analysis was to explore how AYA discuss clinical trials and their access to novel therapeutics through their blogs. Methods: We studied illness blogs from 22 AYA (ages 16-38 years old) with advanced cancer who specifically discussed experiences enrolling in a clinical trial. Nearly 500 excerpts were abstracted from their blogs, and we used qualitative descriptive methodology and thematic analysis to explore their longitudinal perspectives. Results: We describe three themes: (1) "Blinded", which represents the uncertainty in treatment pathway and underrepresentation of AYA in clinical trials, (2) "Totally healthy except for the damn cancer", which represents the numerous challenges associated with meeting eligibility criteria and lack of available clinical trials, and (3) "Go ahead and send me the bill!", which represents the precarious financial challenges associated with participating with clinical trials (both direct costs and indirect costs associated with travel, time away from work) as well as the costs of novel therapeutics. Conclusions: By studying AYA online narratives, we can outline several gaps in accessing clinical trials and generate future research priorities. AYA with advanced cancer are known to have aggressive trajectories, and there are opportunities to integrate patient-reported outcomes and supportive care frameworks embedded within clinical trial study design.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Linda B Callahan
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Lisa C Lindley
- Department of Nursing, University of Tennessee-Knoxville College of Nursing, Knoxville, Tennessee, USA
| | - Claire A Templeman
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Kim Mooney-Doyle
- Department of Nursing, University of Maryland School of Nursing, Baltimore, Maryland, USA
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13
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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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14
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Sarvode S, Vogelzang JR, Sarvode Mothi S, Warren KE, Reardon DA, Yeo KK. Clinical Trial Enrollment Among Adolescent and Young Adults with Primary Central Nervous System Tumors Treated at the Dana-Farber Cancer Institute. J Adolesc Young Adult Oncol 2022; 11:543-549. [PMID: 35049364 DOI: 10.1089/jayao.2021.0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: In recent decades, the survival outcomes among adolescent and young adults (AYAs, 15-39 years) have not improved substantially, especially among AYAs with primary central nervous system (CNS) tumors. While this is likely multifactorial, low participation in clinical trials among AYAs is thought to be a critical contributing factor. In this study, we describe the pattern of clinical trial enrollment among AYAs with primary CNS tumors at our institution. Methods: We performed a retrospective, IRB-approved chart review of AYAs with CNS tumors treated at the Dana-Farber Cancer Institute (DFCI) between January 2009 and December 2018. We used logistic regression analyses and descriptive statistics to analyze this sample and determine the clinical trial enrollment at the pediatric affiliate (Dana-Farber/Boston Children's Cancer and Blood Disorders Center) and adult affiliate (Dana-Farber/Brigham and Women's Cancer Center). Results: Ninety-three AYA patients with primary CNS tumors were treated at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, while 507 patients with primary CNS gliomas were treated at the Dana-Farber/Brigham and Women's Cancer Center. At the pediatric affiliate, 35.4% (33/93) of AYAs were enrolled in a therapeutic clinical trial, while at the adult affiliate, 15.8% (80/507) of AYAs were enrolled in a clinical trial. High-grade gliomas were associated with significantly higher rates of enrollment in the adult affiliate. Conclusions: Clinical trial enrollment remains poor among AYAs with CNS tumors, and clinical trial enrollment participation is modestly higher in the pediatric setting. Our study demonstrates the continued need to evaluate and address factors associated with clinical trial enrollment among AYAs with CNS tumors.
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Affiliation(s)
- Supriya Sarvode
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.,Department of Pediatric Oncology (SS) & Department of Biostatistics (SSM), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jayne R Vogelzang
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Suraj Sarvode Mothi
- Department of Pediatric Oncology (SS) & Department of Biostatistics (SSM), St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Medical Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - David A Reardon
- Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,Department of Medical Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kee Kiat Yeo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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15
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Abrahão R, Alvarez EM, Waters AR, Romero CC, Gosdin MM, Naz H, Pollock BH, Kirchhoff AC, Keegan THM. A qualitative study of barriers and facilitators to adolescents and young adults' participation in cancer clinical trials: Oncologist and patient perspectives. Pediatr Blood Cancer 2022; 69:e29479. [PMID: 34913583 DOI: 10.1002/pbc.29479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/13/2021] [Accepted: 11/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite efforts to increase participation of adolescents and young adults (AYAs; 15-39 years) in cancer clinical trials (CTs), enrollment remains very low. Even when provided access to CTs, AYAs are less likely to participate than children and older adults. A better understanding of oncologist- and AYA survivor-reported barriers, facilitators, and potential areas for CT enrollment improvement is needed. PROCEDURES From December 2019 to August 2020, we conducted 43 semi-structured interviews with oncologists (n = 17) and AYA cancer survivors (n = 26) who were offered and/or participated in CTs at cancer centers in California and Utah. Thematic analyses were used to interpret the findings. RESULTS Oncologists identified a lack of available CTs, strict eligibility criteria, lack of awareness of open CTs, and poor communication between pediatric and adult oncologists as major barriers to enrollment. AYA cancer survivors identified financial and psychosocial barriers, and a poor understanding of what a CT means and its potential benefits as barriers to enrollment. Areas for improvement identified by oncologists and AYAs include educational, financial, and psychosocial support to AYAs. Oncologists also emphasized the need to increase CT availability, improve awareness of open CTs, and better communication between both pediatric and adult oncologists and oncologists and AYAs. CONCLUSIONS For AYAs with cancer, a lack of CT eligibility and physician awareness of open CTs likely factor into their lower CT enrollment. Potential strategies to improve AYA enrollment in CTs require comprehensive collaboration between pediatric and adult institutions, as well as educational, psychosocial, and financial support to AYAs.
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Affiliation(s)
- Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA.,Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Elysia M Alvarez
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA.,Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Austin R Waters
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Crystal C Romero
- Department of Pediatrics, University of California Davis, Sacramento, California, USA
| | - Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Hiba Naz
- Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA
| | - Brad H Pollock
- Department of Public Health Sciences, University of California Davis, Sacramento, California, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
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16
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Siembida EJ, Loomans-Kropp HA, Tami-Maury I, Freyer DR, Sung L, Crosswell HE, Pollock BH, Roth ME. Comparing Barriers and Facilitators to Adolescent and Young Adult Clinical Trial Enrollment Across High- and Low-Enrolling Community-Based Clinics. Oncologist 2022; 27:363-370. [PMID: 35522559 PMCID: PMC9074986 DOI: 10.1093/oncolo/oyac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adolescent and young adult (AYA) patients with cancer are underrepresented on cancer clinical trials (CCTs), and most AYAs are treated in the community setting. Past research has focused on individual academic institutions, but factors impacting enrollment vary across institutions. Therefore, we examined the patterns of barriers and facilitators between high- and low-AYA enrolling community-based clinics to identify targets for intervention. MATERIALS AND METHODS We conducted 34 semi-structured interviews with stakeholders employed used at National Cancer Institute Community Oncology Research Program (NCORP) affiliate sites ("clinics"). Stakeholders (eg, clinical research associates, patient advocates) were recruited from high- and low-AYA enrolling clinics. We conducted a content analysis and calculated the percentage of stakeholders from each clinic type that reported the barrier or facilitator. A 10% gap between high- and low-enrollers was considered the threshold for differences. RESULTS Both high- and low-enrollers highlighted insufficient resources as a barrier and the presence of a patient eligibility screening process as a facilitator to AYA enrollment. High-enrolling clinics reported physician gatekeeping as a barrier and the improvement of departmental collaboration as a facilitator. Low-enrollers reported AYAs' uncertainty regarding the CCT process as a barrier and the need for increased physician endorsement of CCTs as a facilitator. CONCLUSIONS High-enrolling clinics reported more barriers downstream in the enrollment process, such as physician gatekeeping. In contrast, low-enrolling clinics struggled with the earlier steps in the CCT enrollment process, such as identifying eligible trials. These findings highlight the need for multi-level, tailored interventions rather than a "one-size-fits-all" approach to improve AYA enrollment in the community setting.
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Affiliation(s)
- Elizabeth J Siembida
- Institute of Health System Science, Northwell Health, Manhasset, NY, USA,Corresponding author: Elizabeth J. Siembida, Institute of Health System Science, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY 11030, USA. Tel: (516) 600-1757;
| | - Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA,Gastrointestinal and Other Cancers Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Irene Tami-Maury
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - David R Freyer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lillian Sung
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Brad H Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Michael E Roth
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Avutu V, Monga V, Mittal N, Saha A, Andolina JR, Bell DE, Fair DB, Flerlage JE, Frediani JN, Heath JL, Kahn JM, Reichek JL, Super L, Terao MA, Freyer DR, Roth ME. Use of Communication Technology to Improve Clinical Trial Participation in Adolescents and Young Adults With Cancer: Consensus Statement From the Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network. JCO Oncol Pract 2022; 18:224-231. [PMID: 34905405 PMCID: PMC8932547 DOI: 10.1200/op.21.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adolescents and young adults (AYAs; age 15-39 years) with cancer are under-represented in cancer clinical trials because of patient, provider, and institutional barriers. Health care technology is increasingly available to and highly used among AYAs and has the potential to improve cancer care delivery. The COVID-19 pandemic forced institutions to rapidly adopt novel approaches for enrollment and monitoring of patients on cancer clinical trials, many of which have the potential for improving AYA trial participation overall. This consensus statement from the Children's Oncology Group AYA Oncology Discipline Committee reviews opportunities to use technology to optimize AYA trial enrollment and study conduct, as well as considerations for widespread implementation of these practices. The use of remote patient eligibility screening, electronic informed consent, virtual tumor boards, remote study visits, and remote patient monitoring are recommended to increase AYA access to trials and decrease the burden of participation. Widespread adoption of these strategies will require new policies focusing on reimbursement for telehealth, license portability, facile communication between electronic health record systems and advanced safeguards to maintain patient privacy and security. Studies are needed to determine optimal approaches to further incorporate technology at every stage of the clinical trial process, from enrollment through study completion.
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Affiliation(s)
- Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY,Viswatej Avutu, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Floor 14, New York, NY 10065; e-mail:
| | - Varun Monga
- Division of Medical Oncology, Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Nupur Mittal
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aniket Saha
- Division of Pediatric Hematology-Oncology, University of South Carolina School of Medicine, Greenville, SC
| | - Jeffrey R. Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Danielle E. Bell
- Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Douglas B. Fair
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT
| | - Jamie E. Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jessica L. Heath
- Departments of Pediatrics and Biochemistry, University of Vermont, Burlington, VT
| | - Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Jennifer L. Reichek
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leanne Super
- Department of Paediatrics, School of Medicine, Monash University, Melbourne, Australia
| | - Michael A. Terao
- Division of Pediatric Adolescent and Young Adult Hematology and Oncology, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC
| | - David R. Freyer
- Departments of Pediatrics, Medicine, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
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18
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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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19
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Berkman AM, Murphy KM, Siembida EJ, Lau N, Geng Y, Parsons SK, Salsman JM, Roth ME. Inclusion of Patient-Reported Outcomes in Adolescent and Young Adult Phase III Therapeutic Trials: An Analysis of Cancer Clinical Trials Registered on ClinicalTrials.gov. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1820-1827. [PMID: 34838280 PMCID: PMC8630401 DOI: 10.1016/j.jval.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/12/2021] [Accepted: 06/21/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES There is a paucity of research on the impact of cancer treatment on the health-related quality of life (HRQOL) of adolescent and young adult (AYA) patients with cancer. Patient-reported outcomes (PROs) are self-report measures used to assess HRQOL and symptom burden. The extent to which PROs have been included in trials that include common AYA cancer types has not been previously assessed. METHODS Therapeutic phase 3 trials among common AYA cancer types (Hodgkin lymphoma, non-Hodgkin lymphoma, acute lymphoblastic leukemia, sarcomas, and germ cell tumors) initiated between 2007 and 2020 were identified on ClinicalTrials.gov. The proportions and characteristics of trials including a PRO endpoint were assessed. For comparison with an older population, the proportion of breast and colorectal therapeutic phase 3 trials including PRO endpoints were assessed. RESULTS Eighty-seven studies met the inclusion criteria. Overall, 20.7% of therapeutic phase 3 AYA trials included a PRO endpoint, and only one trial published PRO data. Germ cell tumors (42.9%) and non-Hodgkin lymphoma (40%) trials had the highest proportions of PRO inclusion. The European Organization for Research and Treatment of Cancer generic, cancer-specific quality of life questionnaire was the most commonly used PRO measure; nevertheless, the measures used varied within and between cancer types. The proportion of trials including a PRO endpoint did not change significantly between 2007 to 2013 and 2014 to 2020 (18.6% vs 22.7%, P=.79). CONCLUSIONS Few therapeutic phase 3 AYA cancer trials include PRO endpoints, fewer publish PRO data, and there is no homogeneity in the measures administered. Therapeutic trials represent an underused opportunity to capture PRO data in the AYA population with the goal of improving HRQOL outcomes.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Karly M Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Elizabeth J Siembida
- Center for Health Innovation and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Nancy Lau
- Center for Clinical and Translational Research, Palliative Care and Resilience Research Center, Seattle Children's Research Institute, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - 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
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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20
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Roth M, Beauchemin M, Kahn JM, Bleyer A. Patterns of National Cancer Institute-Sponsored Clinical Trial Enrollment in Black Adolescents and Young Adults. Cancer Med 2021; 10:7620-7628. [PMID: 34592782 PMCID: PMC8559464 DOI: 10.1002/cam4.4292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/08/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Both adolescent and young adult (AYA) and Black or African American (hereafter referred to as Black) cancer patients are historically under-enrolled in cancer treatment trials (CTT). The purpose of this study was to quantify enrollment of Black AYAs in National Cancer Institute (NCI)-sponsored CTTs overall and by age, sex, and cancer diagnosis during 2000-2015. METHODS Utilizing data from NCI's Cancer Therapy Evaluation Program and the Surveillance, Epidemiology and End Results (SEER) Program, we assessed CTT enrollment in Black patients with cancer and measured changes in enrollment over time between the study periods 2000-2007 and 2008-2015. Enrollment patterns were compared across age groups (≤14 years [y], 15-19y, 20-29y, 30-39y and 40+ years), sex, and cancer diagnosis. RESULTS From 2000 through 2015, <3% of Black AYAs (20-39y) enrolled on CTTs. While AYAs had significantly higher cancer incidence than children, 20.5% fewer Black AYAs enrolled on CTTs. Enrollment was lowest among Black males 20-29y, with a mean of 18 enrolling in CTTs annually. The proportion of AYA enrollees who were Black did not change significantly over time periods (2000-2007 vs 2008-2015). CONCLUSIONS Few Black AYAs enroll in CTTs each year. Given known benefits of clinical trial participation and the well-documented racial and age-related differences in cancer outcomes, addressing barriers to enrollment in these patients may, in turn, reduce disparities. Targeted interventions aimed at increasing the CTT enrollment of Black cancer patients, particularly young Black men, are urgently needed. PRECIS This study documents that compared with Black children, Black adolescent, and young adult (AYA) patients were less likely to enroll in NCI-sponsored CTTs from 2000 to 2015. Black AYA male enrollment decreased with increasing age, highlighting disparities among this specific population in CTT enrollment.
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Affiliation(s)
- Michael Roth
- Division of Pediatrics, Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Beauchemin
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Justine M Kahn
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Archie Bleyer
- Knight Cancer Institute and Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
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21
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Perspectives of adolescent and young adult cancer survivors: review of community-based discussion boards. J Cancer Surviv 2021; 16:1079-1089. [PMID: 34471949 DOI: 10.1007/s11764-021-01098-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Given the overall increase in the number of adolescent and young adult (AYA) cancer survivors, there has been a growing interest in identifying and implementing effective care for this patient population. To date, there are remaining gaps in research, partly due to challenges in reaching AYA survivors. Our study aimed to assess AYA cancer survivors' concerns using postings from the American Cancer Society Cancer Survivors Network, an online, publicly available forum. METHODS Using qualitative methods, posts from AYA survivors and/or their family/friends in the "Young Cancer Survivors" discussion board from January 2010 to October 2020 were systematically assessed using a previously published cancer survivorship care framework. RESULTS We identified 158 individuals (145 AYA and 13 family or friends), aged 15 to 39 years old, who contributed to 181 posts with concerns regarding cancer survivorship. A majority of posts pertained to surveillance and management of psychosocial effects. Less than half related to concerns about the surveillance and management of physical effects and a few regarding surveillance for recurrence and new cancers. Psychological challenges, including coping and depression, as well as interpersonal topics, including community support and non-family relationships, were the most prevalent psychosocial concerns. Some issues across multiple domains were mentioned. Concerns pertaining to contextual healthcare delivery domains, such as communication, care coordination, and care experience, were less common. CONCLUSIONS Our study found that AYA cancer survivors and their family/friends expressed concerns in several survivorship care domains. Physical and psychosocial issues were most prevalent. IMPLICATIONS FOR CANCER SURVIVORS Interventions tailored towards identifying and addressing the continued unmet needs of AYA cancer survivors are needed. Use of social media may provide opportunities to access this patient population for both clinical and research interventions.
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22
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Ellis JA, Malalasekera VS, Allan C, Choong PF, Hansford JR, Hehir R, Morello N, O'Callaghan S, Orme L, Phillipson N, Rosenthal MA, Sawyer S, Strong R, Super L, Watt A, Williams C, Woollett A, Robertson A, Lewin J. Systems-Level Change to Alleviate Barriers to Cancer Clinical Trial Access for Adolescents and Young Adults in Australia. J Adolesc Young Adult Oncol 2021; 11:173-180. [PMID: 34297611 PMCID: PMC9057899 DOI: 10.1089/jayao.2021.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: International data demonstrate association between clinical trial participation and reduced cancer mortality. Adolescents and young adults (AYA) have low clinical trial enrollment rates. We established a program to understand local barriers and develop targeted solutions that lead to greater AYA clinical trial participation. Methods: A steering committee (SC) with expertise in adult and pediatric oncology, research ethics, and consumer representation was formed. The SC mapped barriers related to AYA trial access and established working groups (WGs) around three themes. Results: The Regulatory Awareness WG identified a lack of understanding of processes that support protocol approval for clinical trials across the AYA age range. A guideline to raise awareness was developed. The Access WG identified challenges for young adults (18–25 years) to access a pediatric hospital to enroll in a pediatric trial. A procedure was developed to streamline applications for access. The first six applications using this procedure have been successful. The Availability WG identified lack of pediatric–adult oncology reciprocal relationships as a barrier to awareness of open trials, and future collaboration. An AYA Craft Group Framework was established to grow relationships within tumor streams across institutions; two craft groups are now operating locally. An additional achievement was a successful request to the Therapeutic Goods Administration for Australian adoption of the Food and Drug Administration Guidance on Considerations for the Inclusion of Adolescent Patients in Adult Oncology Clinical Trials. Conclusion: This multipronged approach to improving AYA clinical trial access has relevance for other health environments. Our knowledge products are available as an online toolkit.
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Affiliation(s)
- Justine A Ellis
- Royal Children's Hospital, Melbourne, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Vajiranee S Malalasekera
- Royal Children's Hospital, Melbourne, Australia.,ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter F Choong
- Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jordan R Hansford
- Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Molecular and Translational Science, Hudson Institute, Monash University, Melbourne, Australia
| | - Ryan Hehir
- Royal Children's Hospital, Melbourne, Australia
| | - Natasha Morello
- Victorian Comprehensive Cancer Centre Consumer Representative, Melbourne, Australia
| | | | - Lisa Orme
- Royal Children's Hospital, Melbourne, Australia.,ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Mark A Rosenthal
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susan Sawyer
- Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Robyn Strong
- Australian and New Zealand Children's Haematology/Oncology Group
| | - Leanne Super
- Royal Children's Hospital, Melbourne, Australia.,Monash Children's Hospital, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
| | - Angela Watt
- Office for Research, Melbourne Health, Melbourne, Australia
| | - Chris Williams
- Royal Children's Hospital, Melbourne, Australia.,Paediatric Integrated Cancer Service, Melbourne, Australia
| | - Anne Woollett
- Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Alexandra Robertson
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeremy Lewin
- ONTrac at PeterMac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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23
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Sae-Hau M, Disare K, Michaels M, Gentile A, Szumita L, Treiman K, Weiss ES. Overcoming Barriers to Clinical Trial Participation: Outcomes of a National Clinical Trial Matching and Navigation Service for Patients With a Blood Cancer. JCO Oncol Pract 2021; 17:e1866-e1878. [PMID: 34077244 DOI: 10.1200/op.20.01068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There are numerous barriers to cancer clinical trial participation in the United States. This paper describes the approach and outcomes of The Leukemia & Lymphoma Society's Clinical Trial Support Center (CTSC), whose nurse navigators assist patients with a blood cancer and their oncologists by identifying all appropriate trials based on clinical data and patient preference, facilitating informed and shared decision making, and minimizing enrollment barriers. METHODS Data on patients served from October 2017 to October 2019 were analyzed using bivariate and multivariate analyses to determine demographic and clinical characteristics associated with enrollment. Reasons for nonenrollment were examined. RESULTS The CTSC opened 906 patient cases during this time frame. Among all US patients with a closed case (n = 750), the clinical trial enrollment rate was 16.1%. Among those with a known enrollment outcome after a trial search (n = 537), the enrollment rate was 22.5%. Multivariate analysis controlling for variables significant in bivariate analyses (insurance, treatment status, Eastern Cooperative Oncology Group performance status, and urban or rural residence) revealed that patients with Medicaid were less likely to enroll than those with private or commercial insurance (adjusted odds ratio, 0.054; CI, 0.003 to 0.899), and patients in treatment or maintenance were less likely to enroll than those relapsed or refractory to most recent therapy (adjusted odds ratio, 0.312; CI, 0.139 to 0.702). Primary reasons for nonenrollment were preference for standard of care (66.3%) and patient passed away (16.1%). CONCLUSION The CTSC is an effective, replicable model for addressing multilevel barriers to clinical trial participation. The findings highlight the need to increase opportunities for trial participation sooner after diagnosis and among patients with Medicaid.
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Affiliation(s)
| | - Kate Disare
- The Leukemia & Lymphoma Society, Rye Brook, NY
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24
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Yeo KK, Burgers DE, Brodigan K, Fasciano K, Frazier AL, Warren KE, Reardon DA. Adolescent and young adult neuro-oncology: a comprehensive review. Neurooncol Pract 2021; 8:236-246. [PMID: 34055371 PMCID: PMC8153805 DOI: 10.1093/nop/npab001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adolescent and young adult (AYA; ages 15-39) patients represent a population that experiences significant challenges in cancer care and research, exemplified by poorer clinical outcomes as well as unmet psychosocial and reproductive health needs. Despite central nervous system (CNS) tumors being one of the most common malignancies diagnosed in the age group, there is a clear paucity of AYA CNS tumor-specific publications, especially those related to the unique psychosocial and reproductive health needs of this population of patients. In this review, we examine various aspects of AYA oncological care including tumor biology, clinical outcome, clinical trials enrollment rate, site of care, unique psychosocial needs, and oncofertility. We assess the current state of these issues, highlight areas of deficiencies, and outline the steps needed to address these concerns. We emphasize the importance of comprehensive molecular testing as part of the diagnostic work-up, expansion of clinical trial availability, access to psychosocial care and oncofertility expertise, and the development of AYA-specific clinical research to define best practices and advancing care for this population.
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Affiliation(s)
- Kee Kiat Yeo
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Darcy E Burgers
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katelynn Brodigan
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Karen Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - A Lindsay Frazier
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine E Warren
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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25
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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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26
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Siembida EJ, Loomans-Kropp HA, Tami-Maury I, Freyer DR, Sung L, Crosswell HE, Pollock BH, Roth ME. Barriers and Facilitators to Adolescent and Young Adult Cancer Trial Enrollment: NCORP Site Perspectives. JNCI Cancer Spectr 2021; 5:pkab027. [PMID: 34104866 PMCID: PMC8178801 DOI: 10.1093/jncics/pkab027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/26/2021] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although it is well documented that adolescents and young adults (AYAs) with cancer have low participation in cancer clinical trials (CCTs), the underlying reasons are not well understood. We used the National Cancer Institute Community Oncology Research Program (NCORP) network to identify barriers and facilitators to AYA CCT enrollment, and strategies to improve enrollment at community-based and minority and/or underserved sites. Methods We performed one-on-one semistructured qualitative interviews with stakeholders (NCORP site principle investigators, NCORP administrators, physicians involved in enrollment, lead clinical research associates or clinical research nurses, nurse navigators, regulatory research associates, patient advocates) in the AYA CCT enrollment process. NCORP sites that included high and low AYA–enrolling affiliate sites and were diverse in geography and department representation (eg, pediatrics, medical oncology) were invited to participate. All interviews were recorded and transcribed. Themes related to barriers and facilitators and strategies to improve enrollment were identified. Results We conducted 43 interviews across 10 NCORP sites. Eleven barriers and 13 facilitators to AYA enrollment were identified. Main barriers included perceived limited trial availability and eligibility, physician gatekeeping, lack of provider and research staff time, and financial constraints. Main facilitators and strategies to improve AYA enrollment included having a patient screening process, physician endorsement of trials, an “AYA champion” on site, and strong communication between medical and pediatric oncology. Conclusions Stakeholders identified several opportunities to address barriers contributing to low AYA CCT enrollment at community-based and minority and/or underserved sites. Results of this study will inform development and implementation of targeted interventions to increase AYA CCT enrollment.
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Affiliation(s)
- Elizabeth J Siembida
- Center for Health Innovation and Outcomes Research, Northwell Health, Manhasset, NY, USA
| | - Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.,Division of Cancer Prevention, Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Rockville, MD, USA
| | - Irene Tami-Maury
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lillian Sung
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Brad H Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Michael E Roth
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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AYA Considerations for Aggressive Lymphomas. Curr Hematol Malig Rep 2021; 16:61-71. [PMID: 33728589 DOI: 10.1007/s11899-021-00607-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Lymphoma is the one of the most common cancer diagnoses among adolescents and young adults (AYAs) aged 15-39. Despite significant advances in outcomes observed in older adults and younger children, improvements in AYAs have lagged behind. The reasons for this are likely multifactorial including disparities in access to health insurance, low rates of enrollment to clinical trials, potential differences in disease biology, and unique psychosocial challenges. Here we will review Hodgkin lymphoma (HL) and primary mediastinal B cell lymphoma (PMBCL), two of the most common aggressive lymphomas that occur in AYAs. We will discuss the current knowledge about disease biology in AYAs, adult and pediatric treatment strategies, novel targeted therapies, and ongoing AYA clinical trials in these lymphoma subtypes. We also will review unique considerations for treatment-related toxicities in AYAs and psychosocial issues relevant to this population. RECENT FINDINGS Pediatric and adult trials in HL and PMBCL have demonstrated that treatment with dose-intense chemotherapeutic regimens with or without radiation results in high cure rates but can also be associated with long-term toxicity which must be considered in this young population. Novel targeted agents such as the antibody-drug conjugate brentuximab vedotin and/or antibodies targeted against PD-1/PD-L1 have demonstrated activity in the relapsed setting and are currently being evaluated in the upfront setting, which may reduce our reliance on therapies associated with long-term toxicity. AYA-focused clinical trials are currently underway to better elucidate the optimal therapy for lymphomas in this age group. There is an urgent need for clinical trials including AYAs in order to increase the knowledge of age-specific outcomes, toxicities, disease biology, and the need to develop comprehensive AYA care models that meet the unique and complex care needs of this patient population.
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28
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Telles CM. A scoping review of literature: What has been studied about adolescents and young adults (AYAs) with cancer? Cancer Treat Res Commun 2021; 27:100316. [PMID: 33545568 DOI: 10.1016/j.ctarc.2021.100316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To map, organize and analyze the articles published in the last five years about AYAs with cancer. METHODS CAPES database and Google Scholar were searched to identify relevant studies from 2015 to February 2020. Eligible articles included empirical or theoretical research, quantitative and/or qualitative studies, targeted AYAs with cancer, addressed different topics related to AYAs such as unmet needs, hospital challenges, interventions or tools based on evidence, as well as political and socioeconomic aspects. RESULTS Of the 161 articles analyzed, 74 (46%) discussed the health system, including hospital dynamics, treatment and interventions during treatment; 63 (39.1%) discussed aspects or interventions that influence the quality of life and mental health of AYAs with cancer; 14 (8.7%) discussed issues related to sexual health; and 10 (6.2%) addressed social, economic and demographic problems of AYAs with cancer. Three types of purposes have been identified in the articles: 118 (73.3%) investigated variables in areas related to AYAs with cancer, aiming to increase the understanding of the phenomenon and the needs of AYAs; 18 (11.2%) intervened on the needs of AYAs with cancer through pilot studies or evidence-based interventions; and 22 (13.7%) aimed to evaluate an intervention previously performed or to evaluate an intervention based on evidence. CONCLUSION There is still much to be researched within the last two categories. In the last three years, these categories have been growing gradually and on a small scale.
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Affiliation(s)
- Camila M Telles
- Graduating in Psychology - Senior year, Positivo University - Curitiba, Paraná, Brazil (Student); Teen Cancer America - Los Angeles, California, the United States of America (Intern Pro Cancer).
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29
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Thielen FW, van Dongen‐Leunis A, Arons AMM, Ladestein JR, Hoogerbrugge PM, Uyl‐de Groot CA. Cost-effectiveness of Anti-CD19 chimeric antigen receptor T-Cell therapy in pediatric relapsed/refractory B-cell acute lymphoblastic leukemia. A societal view. Eur J Haematol 2020; 105:203-215. [PMID: 32289184 PMCID: PMC7497258 DOI: 10.1111/ejh.13427] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In several studies, the chimeric antigen receptor T-cell therapy tisagenlecleucel demonstrated encouraging rates of remission and lasting survival benefits in pediatric patients with relapsed/refractory (r/r) acute lymphoblastic leukemia (ALL). We assessed the cost-effectiveness of tisagenlecleucel (list price: 320 000 EUR) among these patients when compared to clofarabine monotherapy (Clo-M), clofarabine combination therapy (Clo-C), and blinatumomab (Blina) from both a healthcare and a societal perspective. We also assessed future medical and future non-medical consumption costs. METHODS A three-state partitioned survival model was used to simulate a cohort of pediatric patients (12 years of age) through different disease states until the end of life (lifetime horizon). Relevant outcomes were life years, quality-adjusted life years (QALYs), healthcare costs, societal costs, and the incremental cost-effectiveness ratio (ICER). Uncertainty was explored through deterministic and probabilistic sensitivity analyses as well as through several scenario analyzes. RESULTS Total discounted costs for tisagenlecleucel were 552 679 EUR from a societal perspective, which was much higher than the total discounted costs from a healthcare perspective (ie, 409 563 EUR). Total discounted societal costs for the comparator regimens ranged between 160 803 EUR for Clo-M and 267 259 EUR for Blina. Highest QALYs were estimated for tisagenlecleucel (11.26), followed by Blina (2.25), Clo-C (1.70) and Clo-M (0.74). Discounted societal ICERs of tisagenlecleucel ranged between 31 682 EUR/QALY for Blina and 37 531 EUR/QALY for Clo-C and were considered cost-effective with a willingness-to-pay (WTP) threshold of 80 000 EUR/QALY. None of the scenarios exceeded this threshold, and more than 98% of the iterations in the probabilistic sensitivity analysis were cost-effective. DISCUSSION At the current price and WTP threshold, tisagenlecleucel is cost-effective from both a healthcare and a societal perspective. Nevertheless, long-term effectiveness data are needed to validate the several assumptions that were necessary for this model.
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Affiliation(s)
- Frederick W. Thielen
- Erasmus School of Health Policy & Management/Institute for Medical Technology AssessmentErasmus UniversityRotterdamThe Netherlands
| | - Annemieke van Dongen‐Leunis
- Erasmus School of Health Policy & Management/Institute for Medical Technology AssessmentErasmus UniversityRotterdamThe Netherlands
| | | | | | | | - Carin A. Uyl‐de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology AssessmentErasmus UniversityRotterdamThe Netherlands
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30
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Reed DR, Naghavi A, Binitie O. Sarcoma as a Model for Adolescent and Young Adult Care. J Oncol Pract 2020; 15:239-247. [PMID: 31075215 DOI: 10.1200/jop.18.00684] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sarcomas occur across all ages and are relatively abundant in the adolescent and young adult populations compared with older adults. Because of an overall rarity combined with a broad diversity of diagnoses, expertise is often concentrated in comprehensive cancer centers. The sarcoma model of care is an excellent model for overall adolescent and young adult care. We summarize some of the natural advantages of the field for developing adolescent and young adult programs, review management and referral touchpoints, and summarize recent biologic and clinical trial insights that have affected sarcoma management recently.
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Affiliation(s)
- Damon R Reed
- 1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arash Naghavi
- 1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Odion Binitie
- 1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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31
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Skiba MB, McElfresh JJ, Howe CL, Crane TE, Kopp LM, Jacobs ET, Thomson CA. Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. J Adolesc Young Adult Oncol 2020; 9:315-327. [DOI: 10.1089/jayao.2019.0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Meghan B. Skiba
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer J. McElfresh
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Carol L. Howe
- University of Arizona Health Sciences Library, 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
| | - Elizabeth T. Jacobs
- 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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Dickens DS, Roth ME, Pollock BH, Langevin AM. Understanding the Barriers to Pediatric Oncologist Engagement and Accrual to Clinical Trials in National Cancer Institute-Designated Community Oncology Research Programs. JCO Oncol Pract 2020; 16:e1060-e1066. [PMID: 32396490 PMCID: PMC7564137 DOI: 10.1200/jop.19.00707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE: Clinical trial participation leads to progress in cancer care. Principal investigators (PIs) and clinical research associates (CRAs) play key roles in the provision and maintenance of clinical trial portfolios at their sites. Previous studies have evaluated the educational and resource needs of adult oncology providers, but nothing to date has focused on providers of pediatric oncology care. We aimed to identify the educational needs and clinical trial participation barriers at National Cancer Institute Community Oncology Research Program (NCORP) Children’s Oncology Group (COG) sites to improve the quality of site investigator engagement. METHODS: Quality improvement surveys of pediatric clinical research staff at NCORP sites were performed. The first was a web-based inquiry of NCORP COG PIs and lead CRAs to assess their general understanding of NCORP organizational structure and needs. The second survey of COG PIs was conducted by one-on-one telephone interviews aimed at identifying specific barriers to physician engagement and patient enrollment in clinical trial research. RESULTS: The majority of NCORP COG PIs and CRAs (63%) reported an incomplete understanding of NCORP structure, with approximately half expressing interest in developing stronger collaborations and engagement. Most NCORP COG PIs reported at least one shared barrier to clinical trial enrollment (78%), with inadequate protected time and research support (39% each) being the most frequently cited barriers. CONCLUSIONS: Contributions to pediatric cancer clinical research at COG NCORP sites could be enhanced through improved education, resources, and time allocation.
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Affiliation(s)
- David S Dickens
- Department of Pediatrics, Division of Hematology, Oncology and Bone Marrow Transplantation, University of Iowa, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Michael E Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brad H Pollock
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Comprehensive Cancer Center, Davis, CA
| | - Anne-Marie Langevin
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Health San Antonio, San Antonio, TX
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Papageorgiou GI, Razis ED. CNS Tumors in Adolescents and Young Adults: The Need for a Holistic Specialized Approach. JCO Oncol Pract 2020; 16:155-162. [DOI: 10.1200/jop.18.00767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CNS tumors are one of the most common causes of cancer-related death in the 15- to 39-year-old age group. The management of adolescents and young adults (AYAs) who are diagnosed with brain tumors presents unique endocrine, developmental, and psychosocial issues. AYAs are frequently diagnosed late, after a prolonged period of misdiagnosis. The epidemiology, biology, prognosis, and overall management of these tumors differ from those of both older and younger age groups. AYAs are usually in a transitional phase in their lives, and brain tumors in this age group carry a better prognosis than in older adults; thus, special attention should be paid to survivorship care. Fertility and other treatment-related sequelae that affect the quality of life, as well as the increased risk of secondary malignancies in long-term survivors, are such examples. Although most AYAs are managed by adult or, to a lesser extent pediatric, oncologists, a multidisciplinary approach in the setting of specialized centers with increased participation in clinical trials is preferable. End-of-life and palliative care remain an unmet need for these patients, because most physicians lack the training to discuss such issues with young patients.
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Adler FR, Green AM, Şekercioğlu ÇH. Citizen science in ecology: a place for humans in nature. Ann N Y Acad Sci 2020; 1469:52-64. [PMID: 32216157 DOI: 10.1111/nyas.14340] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/18/2020] [Indexed: 12/01/2022]
Abstract
By involving the public, citizen science runs against the grain of an idealized science that leaves out the human element, and thus provides new opportunities for ecological research and society. We classify the goals of citizen science in ecology and environment into four broad categories: (1) scientific, (2) participant benefits, (3) community, and (4) policy. Although none of these goals have been well studied, we review the literature showing that these projects are most effective in tracking ecological trends over large swaths of space and time, and discuss the challenges of recruiting, training, retaining, and educating participants, maintaining and disseminating high-quality data, and connecting with the larger community and policy. Biomedical studies, where patients participate in their own treatment in randomized trials, provide an interesting comparison with citizen science in ecology, sharing challenges in recruitment and involvement of nonscientists and ethical conduct of research. Future study will help address the ethical difficulties and enhance ways for citizen science in ecology and the environment to complement scientific discovery, involve and educate the public, and guide policy founded in science and the local community.
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Affiliation(s)
- Frederick R Adler
- School of Biological Sciences, University of Utah, Salt Lake City, Utah.,Department of Mathematics, University of Utah, Salt Lake City, Utah
| | - Austin M Green
- School of Biological Sciences, University of Utah, Salt Lake City, Utah
| | - Çağan H Şekercioğlu
- School of Biological Sciences, University of Utah, Salt Lake City, Utah.,Conservation Science Group, Department of Zoology, Cambridge University, Cambridge, United Kingdom.,Department of Molecular Biology and Genetics, Koç University, Istanbul, Turkey
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Hagström J, Ander M, Cernvall M, Ljótsson B, Wiman HW, von Essen L, Woodford J. Heeding the psychological concerns of young cancer survivors: a single-arm feasibility trial of CBT and a cognitive behavioral conceptualization of distress. PeerJ 2020; 8:e8714. [PMID: 32219023 PMCID: PMC7085902 DOI: 10.7717/peerj.8714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background A subgroup of adolescent and young adult (AYA) survivors of cancer during adolescence report high levels of psychological distress. To date, evidence-based psychological interventions tailored to the cancer-related concerns experienced by this population are lacking. The present study aimed to (1) examine the feasibility and preliminary efficacy of an individualized cognitive behavioral therapy (CBT) intervention for AYA survivors of cancer during adolescence; and (2) identify and conceptualize cancer-related concerns as well as maintaining factors using cognitive-behavioral theory. Methods A single-arm trial, whereby AYA survivors of cancer during adolescence (aged 17–25 years) were provided individualized face-to-face CBT at a maximum of 15 sessions. Clinical outcomes were assessed at baseline, post-intervention, and three-month follow-up. Intervention uptake, retention, intervention delivery, and reliable change index scores were examined. An embedded qualitative study consisted of two unstructured interviews with each participant pre-intervention. Along with individual behavioral case formulations developed to guide the intervention, interview data was analyzed to identify and conceptualize cancer-related concerns and potential maintaining factors. Results Ten out of 213 potential participants invited into the study were included, resulting in an overall participation rate of 4.7%. Nine participants completed the intervention, with respectively seven and eight participants completing the post-intervention and three month follow-up assessment. The majority of reported cancer-related concerns and maintaining factors were conceptualized into four themes: social avoidance, fear of emotions and bodily symptoms, imbalance in activity, and worry and rumination. Conclusions Given significant recruitment difficulties, further research is required to examine barriers to help-seeking in the AYA cancer survivor population. However, the conceptualization of cancer-related concerns and maintaining factors experienced by the population may represent an important first step in the development of psychological support tailored toward AYA cancer survivors’ unique needs.
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Affiliation(s)
- Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Malin Ander
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Martin Cernvall
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Henrik W Wiman
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
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36
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Siembida EJ, Loomans-Kropp HA, Trivedi N, O’Mara A, Sung L, Tami-Maury I, Freyer DR, Roth M. Systematic review of barriers and facilitators to clinical trial enrollment among adolescents and young adults with cancer: Identifying opportunities for intervention. Cancer 2020; 126:949-957. [PMID: 31869454 PMCID: PMC7029803 DOI: 10.1002/cncr.32675] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/28/2019] [Accepted: 11/23/2019] [Indexed: 01/01/2023]
Abstract
Adolescents and young adults (AYAs) are underrepresented in cancer clinical trials (CCTs). Limited trial enrollment slows progress in improving survival rates and prevents the collection of valuable biospecimens. A systematic literature review was conducted to assess barriers and facilitators to AYA enrollment in CCTs and to identify opportunities to improve enrollment. The PubMed MEDLINE, Web of Science, Scopus, and PsycINFO databases were searched to identify studies relevant to AYA CCT enrollment. Eligibility criteria included the qualitative and/or quantitative evaluation of barriers and facilitators to AYA enrollment. One hundred fifty-five unique publications were identified; 13 were included in the final analysis. Barriers to AYA enrollment in CCTs included a lack of existing trials applicable to the patient population, limited access to available CCTs, and a lack of physician awareness of relevant trials. Facilitators of enrollment included optimizing the research infrastructure, improving the awareness of available CCTs among providers, and enhancing communication about CCTs between providers and patients. In conclusion, the limited available research reports institution- and patient-level barriers and facilitators to AYA CCT enrollment. Because of persistent disparities in AYA enrollment, there is an urgent need to further identify the barriers and facilitators to AYA CCT enrollment to determine actionable areas for intervention.
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Affiliation(s)
- Elizabeth J. Siembida
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Outcomes Research Branch, Division of Cancer Control and Population Sciences. National Cancer Institute, Rockville, MD, USA
| | - Holli A. Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | - Neha Trivedi
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
- Health Communication and Informatics Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | - Lillian Sung
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Irene Tami-Maury
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R. Freyer
- Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Children’s Hospital Los Angeles and USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Michael Roth
- Department of Pediatrics, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Roth M, Mittal N, Saha A, Freyer DR. The Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network: A New Model for Addressing Site-Level Factors Impacting Clinical Trial Enrollment. J Adolesc Young Adult Oncol 2020; 9:522-527. [PMID: 32077782 DOI: 10.1089/jayao.2019.0139] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: In the Children's Oncology Group (COG), there is precedent for scientific committees designating institutional Responsible Investigators (RIs) to promote clinical trial enrollment and coordinate related research activities. In response to low enrollment of adolescents and young adults (AYAs) on COG clinical trials, the COG AYA RI Network was established. Leveraging this network, we undertook an initiative to identify site-level factors influencing AYA enrollment. Methods: The overarching goal of the AYA RI Network is to increase AYA enrollment onto COG trials. At each site, RIs highlight AYA disparities, facilitate activation of relevant trials, improve recruitment processes, and expand interactions with medical oncologists. Through a series of monthly national webinars and workshops, participating RIs reported local barriers and facilitators enrolling AYAs. A mixed-methods approach was utilized to determine major themes of factors affecting site-level enrollment. Results: For this report, there were 145 participating RIs representing 122 demographically and geographically diverse sites. There were 13 interactive webinars and 3 symposia involving 25 speakers focused on addressing enrollment barriers. Major thematic categories for site-level barriers were (1) Lack of available trials; (2) Poor communication between pediatric and medical oncology; (3) Logistical constraints to accessing trials; and (4) Need for leadership support, sufficient resources and appropriate policies. Conclusion: The COG AYA RI Network has identified multiple site-level barriers impeding AYA clinical trial enrollment and represents a novel model for developing and implementing appropriate solutions through a nationally coordinated strategy.
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Affiliation(s)
- Michael Roth
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nupur Mittal
- Division of Hematology/Oncology, Rush University Children's Hospital, Chicago, Illinois, USA
| | - Aniket Saha
- BI-LO Charities Children's Cancer Center, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina, USA
| | - David R Freyer
- Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Roth ME, Unger JM, O'Mara AM, Lewis MA, Budd T, Johnson RH, Pollock BH, Blanke C, Freyer DR. Enrollment of adolescents and young adults onto SWOG cancer research network clinical trials: A comparative analysis by treatment site and era. Cancer Med 2020; 9:2146-2152. [PMID: 32009305 PMCID: PMC7064039 DOI: 10.1002/cam4.2891] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background Few adolescents and young adults (AYAs, 15‐39 years old) enroll onto cancer clinical trials, which hinders research otherwise having the potential to improve outcomes in this unique population. Prior studies have reported that AYAs are more likely to receive cancer care in community settings. The National Cancer Institute (NCI) has led efforts to increase trial enrollment through its network of NCI‐designated cancer centers (NCICC) combined with community outreach through its Community Clinical Oncology Program (CCOP; replaced by the NCI Community Oncology Research Program in 2014). Methods Using AYA proportional enrollment (the proportion of total enrollments who were AYAs) as the primary outcome, we examined enrollment of AYAs onto SWOG therapeutic trials at NCICC, CCOP, and non‐NCICC/non‐CCOP sites from 2004 to 2013 by type of site, study period (2004‐08 vs 2009‐13), and patient demographics. Results Overall, AYA proportional enrollment was 10.1%. AYA proportional enrollment decreased between 2004‐2008 and 2009‐2013 (13.1% vs 8.5%, P < .001), and was higher at NCICCs than at CCOPs and non‐NCICC/non‐CCOPs (14.1% vs 8.3% and 9.2%, respectively; P < .001). AYA proportional enrollment declined significantly at all three site types. Proportional enrollment of AYAs who were Black or Hispanic was significantly higher at NCICCs compared with CCOPs or non‐NCICC/non‐CCOPs (11.5% vs 8.8, P = .048 and 11.5% vs 8.6%, P = .03, respectively). Conclusion Not only did community sites enroll a lower proportion of AYAs onto cancer clinical trials, but AYA enrollment decreased in all study settings. Initiatives aimed at increasing AYA enrollment, particularly in the community setting with attention to minority status, are needed.
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Affiliation(s)
- Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph M Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ann M O'Mara
- Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | | | - Troy Budd
- Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Rebecca H Johnson
- Department of Pediatric Hematology/Oncology, Mary Bridge Children's Hospital and Health Center and Tacoma General Hospital, Tacoma, WA, USA
| | - Brad H Pollock
- Department of Public Health Sciences and the UC Davis Comprehensive Cancer Center, University of California, Davis, CA, USA
| | - Charles Blanke
- Southwest Oncology Group Chair's Office and Knight Cancer Center Institute, Oregon Health & Science University, Portland, OR, USA
| | - David R Freyer
- Departments of Pediatrics and Medicine, Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Marshall CS, Grimes A. Pediatric Physician Management as a Predictor of Clinical Trial Enrollment in Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2019; 9:183-189. [PMID: 31800344 DOI: 10.1089/jayao.2019.0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The Adolescent and Young Adult (AYA) gap describes the drop-off in survivorship improvement among 15-39-year-olds compared with patients with cancer under 15 or over 39. A large body of literature explores why this population experiences lower rates of trial enrollment, an issue of particular importance since this single factor is thought to have the greatest impact on the decrease in survivorship. The purpose of this research is primarily to identify whether or not AYA patients within a large academic center who were treated by a pediatric specialist were more likely to be enrolled in a clinical trial. Methods: A retrospective cohort study was conducted by chart review of AYA cancer patients within a large academic institution diagnosed from 2014 to 2016. Information, including physician specialty, sex, cancer subtype, age, and ethnicity were extracted and analyzed in relation to enrollment data from the clinical trials office. Results: Patients managed by a pediatric specialist were over 10 times more likely (p < 0.01) than those treated by adult specialists to be enrolled in a clinical trial. When stratified by cancer subtype, pediatric specialist management still predicted trial enrollment in subtypes more common in younger patients, including germ cell and osseous neoplasms, leukemia, and lymphoma. Neither age, sex, nor ethnicity correlated significantly with enrollment. Conclusion: These data not only depict the necessity of abandoning traditional age cutoffs when dealing with AYA cancer, but also reveal the need for further study to understand and ultimately rectify the discrepancy between pediatric and adult utilization of clinical trial enrollment.
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Affiliation(s)
- Callie S Marshall
- Department of Pediatric Hematology/Oncology, The University of Texas Health at San Antonio, San Antonio, Texas
| | - Allison Grimes
- Department of Pediatric Hematology/Oncology, The University of Texas Health at San Antonio, San Antonio, Texas
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40
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de Rojas T, Neven A, Terada M, García-Abós M, Moreno L, Gaspar N, Péron J. Access to Clinical Trials for Adolescents and Young Adults With Cancer: A Meta-Research Analysis. JNCI Cancer Spectr 2019; 3:pkz057. [PMID: 32337483 PMCID: PMC7050014 DOI: 10.1093/jncics/pkz057] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The 18-year-old age limit for inclusion in clinical trials constitutes a hurdle for adolescents and young adults (AYAs) with cancer. We analyzed the impact of this age barrier on the access of AYAs to cancer trials and novel therapies. METHODS ClinicalTrials.gov was searched to identify all the trials including patients with 10 malignancies relevant for AYAs (January 2007 to July 2018). The trials were categorized as pediatric (patients <18 y), adult (≥18 y), and transitional (including adult and pediatric patients). Transitional trials with a lower limit between 12 and 18 years and an upper limit younger than 40 years were considered AYA-specific. RESULTS Of 2764 identified trials, 2176 were included: 79% adult, 19% transitional, 2% pediatric. Five trials were AYA-specific. The proportion of academic trials was higher for transitional (69%; 288 of 421) than for adult trials (48%; 832 of 1718) (P < .0001). The total number of new trials increased over the years (156 in 2007; 228 in 2017); however, the number of transitional trials remained stable. The availability of trials increased with age, with a major increase at age 18 years: at age 17 years, 20% (442 of 2176) of trials were potentially accessible vs 95% (2075 of 2176) at 18 years. For trials investigating targeted therapies, this increase was 460% (197 trials available at age 17 years; 901 at 18 years) and for immunotherapies, 1200% (55 at age 17 years; 658 at 18 years). CONCLUSIONS AYAs have limited access to cancer trials and innovative therapies, with no improvement over the last decade. The 18-years-old age limit continues to be a major hurdle. Our findings are consistent with the internationally supported idea that age inclusion criteria in oncological trials should be changed.
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Affiliation(s)
| | | | | | - Miriam García-Abós
- European Organisation for Research and Treatment of Cancer HQ, Brussels, Belgium
- Pediatric Oncology Department, Hospital Donostia, San Sebastian, Spain
| | - Lucas Moreno
- Clinical Research Unit, Hospital Niño Jesús, Madrid, Spain
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Péron
- Medical Department, Brussels, Belgium
- Medical Oncology Department, Institut de Cancérologie des Hospices Civils de Lyon, Université Lyon 1, Lyon, France
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Close AG, Dreyzin A, Miller KD, Seynnaeve BKN, Rapkin LB. Adolescent and young adult oncology-past, present, and future. CA Cancer J Clin 2019; 69:485-496. [PMID: 31594027 DOI: 10.3322/caac.21585] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 06/26/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
There are nearly 70,000 new cancer diagnoses made annually in adolescents and young adults (AYAs) in the United States. Historically, AYA patients with cancer, aged 15 to 39 years, have not shown the same improved survival as older or younger cohorts. This article reviews the contemporary cancer incidence and survival data through 2015 for the AYA patient population based on the National Cancer Institute's Surveillance, Epidemiology, and End Results registry program and the North American Association of Central Cancer Registries. Mortality data through 2016 from the Centers for Disease Control and Prevention's National Center for Health Statistics are also described. Encouragingly, absolute and relative increases in 5-year survival for AYA cancers have paralleled those of childhood cancers since the year 2000. There has been increasing attention to these vulnerable patients and improved partnerships and collaboration between adult and pediatric oncology; however, obstacles to the care of this population still occur at multiple levels. These vulnerabilities fall into 3 significant categories: research efforts and trial enrollment directed toward AYA malignancies, access to care and insurance coverage, and AYA-specific psychosocial support. It is critical for providers and health care delivery systems to recognize that the AYA population remains vulnerable to provider and societal complacency.
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Affiliation(s)
- Allison G Close
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra Dreyzin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Brittani K N Seynnaeve
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Louis B Rapkin
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Rao P, Segel JE, McGregor LM, Lengerich EJ, Drabick JJ, Miller B. Attendance at National Cancer Institute and Children's Oncology Group Facilities for Children, Adolescents, and Young Adults with Cancer in Pennsylvania: A Population-Based Study. J Adolesc Young Adult Oncol 2019; 9:47-54. [PMID: 31600095 DOI: 10.1089/jayao.2019.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer are a vulnerable population with decreased attendance at National Cancer Institute (NCI) comprehensive cancer centers and Children's Oncology Group (COG) facilities. Decreased attendance at NCI/COG facilities has been associated with poor cancer outcomes. The objective of this study was to evaluate cancer care patterns of AYAs compared with children, within Pennsylvania, and factors associated with attending an NCI/COG facility. Methods: Data from the Pennsylvania Cancer Registry between 2010 and 2015 for patients aged 0-39 years at cancer diagnosis were used. Primary analyses focused on age at diagnosis, insurance status, race, ethnicity, gender, cancer type, stage, diagnosis year, and distance to the NCI/COG facility. The primary outcome was receipt of care at an NCI/COG facility. Odds ratios (ORs) were calculated using multivariable logistic regression models. Sensitivity analyses were conducted to test and estimate robustness. Results: A sample of 15,002 patients, ages 0-39, was obtained, including 8857 patients (59%) who attended an NCI/COG facility. Patients were significantly less likely to attend an NCI/COG facility if they were aged 31-39 years (OR 0.054, 95% confidence interval [CI] 0.04-0.07), non-White (OR 0.890, 95% CI 0.80-0.99), Hispanic (OR 0.701, 95% CI 0.59-0.83), female (OR 0.915, 95% CI 0.84-1.00), had Medicaid insurance (OR 0.836, 95% CI 0.75-0.93), and lived further from an NCI/COG facility. Sensitivity analyses largely corroborated the performed estimates. Conclusions: AYAs with cancer in Pennsylvania have disproportionate attendance at specialized NCI/COG facilities across a variety of demographic domains. Enhancing the attendance of AYAs with cancer at these specialized centers is crucial to improve cancer outcomes.
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Affiliation(s)
- Pooja Rao
- Division of Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Joel E Segel
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania.,Penn State Cancer Institute, Hershey, Pennsylvania
| | - Lisa M McGregor
- Division of Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania.,Penn State Cancer Institute, Hershey, Pennsylvania
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Barbara Miller
- Division of Pediatric Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania.,Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Hershey, Pennsylvania
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Siegel SE, Stock W, Johnson RH, Advani A, Muffly L, Douer D, Reed D, Lewis M, Freyer DR, Shah B, Luger S, Hayes-Lattin B, Jaboin JJ, Coccia PF, DeAngelo DJ, Seibel N, Bleyer A. Pediatric-Inspired Treatment Regimens for Adolescents and Young Adults With Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: A Review. JAMA Oncol 2019; 4:725-734. [PMID: 29450465 DOI: 10.1001/jamaoncol.2017.5305] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance The incidence of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) in adolescent and young adult (AYA) patients (age range, 15-39 years) in the United States is increasing at a greater rate than in younger or older persons. Their optimal treatment has been increasingly debated as pediatric regimens have become more widely used in the age group. This review compares the basic features of pediatric and adult chemotherapy regimens for ALL and LBL, recognizes and describes the challenges of the pediatric regimen, and suggests strategies to facilitate its adoption for AYAs with ALL and LBL. Observations All but 2 of 25 published comparisons of outcomes with pediatric and adult regimens for ALL and LBL in AYAs and 1 meta-analysis favor the pediatric regimen. After more than a half-century of clinical trials of the pediatric regimens, including at least 160 phase 3 trials in the United States, the pediatric regimens have become far more complex than most adult regimens. Asparaginase, a critical component of the pediatric regimens, is more difficult to administer to AYAs (and older patients) but nonetheless has a favorable benefit to toxicity ratio for AYAs. A dramatic reduction in outcome of ALL and LBL during the AYA years (the "survival cliff") is coincident with similar reductions in proportions of AYAs referred to academic centers and enrolled on clinical trials (the "accrual cliff" and "referral cliff"). Conclusions and Relevance The accumulating data increasingly support treating AYAs with ALL and LBL with a pediatric-inspired regimen or an approved institutional or national clinical trial tailored for this patient group. A need to develop clinical trials specifically for AYAs and to encourage their participation is paramount, with a goal to improve both the quantity and quality of survival.
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Affiliation(s)
| | - Wendy Stock
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Section of Hematology/Oncology, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Rebecca H Johnson
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Clinical Oncology Research Program (All in the National Cancer Institute National Clinical Trials Network).,Pediatric Hematology/Oncology, Mary Bridge Children's Hospital and Health Center and Tacoma General Hospital, Tacoma, Washington
| | - Anjali Advani
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lori Muffly
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Blood and Marrow Transplantation, Department of Medicine, Stanford University, Palo Alto, California
| | - Dan Douer
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Damon Reed
- National Pediatric Cancer Foundation, Tampa, Florida.,Moffitt Cancer Center, Tampa, Florida
| | - Mark Lewis
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Hematology/Oncology, Intermountain Healthcare, Salt Lake City, Utah
| | - David R Freyer
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Keck Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Bijal Shah
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Moffitt Cancer Center, Tampa, Florida.,National Comprehensive Cancer Network
| | - Selina Luger
- ECOG-ACRIN Cancer Research Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brandon Hayes-Lattin
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
| | - Jerry J Jaboin
- Department of Radiation Medicine, Oregon Health and Science University, Portland.,NRG Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group), National Cancer Institute, Bethesda, Maryland
| | - Peter F Coccia
- Children's Oncology Group (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,National Comprehensive Cancer Network.,Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | - Daniel J DeAngelo
- Alliance for Clinical Trials in Oncology (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nita Seibel
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | - Archie Bleyer
- SWOG (National Cancer Institute-Sponsored National Clinical Trials Network Cooperative Group).,Department of Radiation Medicine, Oregon Health and Science University, Portland
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44
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Mitchell L, Tam S, Gupta AA. Crucial Conversations: Addressing Informational Needs of Adolescents and Young Adults Diagnosed With Cancer. Clin J Oncol Nurs 2019; 22:483-486. [PMID: 30239526 DOI: 10.1188/18.cjon.483-486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescents and young adults (AYAs) with cancer aged 15-39 years have unique medical, psychosocial, and informational needs. At the time of diagnosis, they are often going through important life milestones, such as establishing their independence, attending school or work, and maintaining romantic and/or family relationships. This article describes some of the critical time points for AYAs with cancer and the resources available to support the nursing profession in meeting the unique care needs of this population.
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Affiliation(s)
- Laura Mitchell
- Princess Margaret Cancer Centre at the University of Toronto
| | - Seline Tam
- Princess Margaret Cancer Centre at the University of Toronto
| | - Abha A Gupta
- Princess Margaret Cancer Centre at the University of Toronto
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45
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Mittal N, Davidson J, Martinez MF, Sanchez R, Sane N, Giordano L, Choi DK, Kent P, Dighe D, Iqbal A, Kiely C, Breen K, Quigley JG, Catchatourian R, Gitelis S, Schmidt ML. A Tri-Institutional Approach to Address Disparities in Children's Oncology Group Clinical Trial Accrual for Adolescents and Young Adults and Underrepresented Minorities. J Adolesc Young Adult Oncol 2019; 8:227-235. [DOI: 10.1089/jayao.2018.0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nupur Mittal
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Jonathan Davidson
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Mario F. Martinez
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Reynaldo Sanchez
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Nitin Sane
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Giordano
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Daniel K. Choi
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Paul Kent
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Dipti Dighe
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Asneha Iqbal
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Cathleen Kiely
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Kathleen Breen
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - John G. Quigley
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Rosalind Catchatourian
- Department of Pediatrics, John. H. Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Steven Gitelis
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Mary Lou Schmidt
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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46
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Docherty SL, Crane S, Haase JE, Robb SL. Improving recruitment and retention of adolescents and young adults with cancer in randomized controlled clinical trials. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0215/ijamh-2018-0215.xml. [PMID: 30973826 DOI: 10.1515/ijamh-2018-0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022]
Abstract
Participation of adolescents and young adults (AYAs) with cancer in randomized clinical trials (RCTs) is necessary to advance treatments and psychosocial programs. Exploring AYAs experiences in an RCT will inform strategies to support recruitment and retention. A qualitative design was used to study the experiences of 13 AYAs in the Stories and Music for Adolescent and Young Adult Resilience during Transplant I (SMART I) trial. Key themes included: Weighing the Pros and Cons; Randomization Preferences; Completing Measures; and Worthwhile Experience. The experiences of AYAs during RCTs can bring insights that inform the design and management of AYA trials. Strategies include improving assent/consent processes, design of electronic interfaces and encouraging researcher flexibility.
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Affiliation(s)
- Sharron L Docherty
- Duke University, School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC 27710, USA, Phone: (+919) 668-3836
| | - Stacey Crane
- Indiana University, School of Nursing, Indianapolis, IN, USA
| | - Joan E Haase
- Indiana University, School of Nursing, Indianapolis, IN, USA
| | - Sheri L Robb
- Indiana University, School of Nursing, Indianapolis, IN, USA
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47
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Lo AC, Laperriere N, Hodgson D, Bouffet E, Nicholson J, McKenzie M, Hukin J, Cheng S, Goddard KJ. Canadian patterns of practice for intracranial germ cell tumors in adolescents and young adults. J Neurooncol 2019; 143:289-296. [PMID: 30937607 DOI: 10.1007/s11060-019-03159-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The study objectives were to describe patterns of practice for intracranial germ cell tumors (IGCT) in adolescents and young adults (AYA) and to determine factors associated with practice patterns. METHODS A survey was written containing questions on the management of two 17-year old males, one with localized pineal germinoma and the other with localized pineal non-germinomatous germ cell tumor (NGGCT). An invitation to participate anonymously in the survey was e-mailed to 119 oncologists who treat brain tumors across Canada. RESULTS Seventy-two (61%) of the 119 oncologists participated in the study. For the germinoma case, the most common treatment approaches were whole ventricular radiotherapy (WVRT) and chemotherapy (CH) (56%), WVRT alone (15%), and craniospinal radiotherapy (CSRT) alone (10%); for physicians recommending WVRT + CH, most frequently selected whole ventricular doses were 24 Gy (57%) and 18 Gy (20%). Chemotherapy was included in the treatment of germinoma by 96% of pediatric physicians vs. 54% of adult physicians (P = 0.001). The most common treatment approaches for NGGCT were CSRT + CH (44%), WVRT + CH (21%), and pineal gland RT + CH (15%). The selection of craniospinal vs. smaller-volume RT was not associated with the physicians' specialty, percentage of practice treating brain tumors, number of IGCTs seen, or size of institution. CONCLUSIONS There is wide variation in the management of IGCT in AYA across Canada. A 17-year old male with a localized pineal germinoma is highly likely to receive chemotherapy if managed by a pediatric oncologist, while the same patient is much less likely to receive chemotherapy if managed by an adult oncologist.
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Affiliation(s)
- Andrea C Lo
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada. .,Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada. .,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada. .,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.
| | - Normand Laperriere
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada.,The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - David Hodgson
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada.,The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Eric Bouffet
- The Hospital of Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.,University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | | | - Michael McKenzie
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Juliette Hukin
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Sylvia Cheng
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Karen J Goddard
- BC Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada.,British Columbia Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.,University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
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48
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Hydeman JA, Uwazurike OC, Adeyemi EI, Beaupin LK. Survivorship needs of adolescent and young adult cancer survivors: a concept mapping analysis. J Cancer Surviv 2019; 13:34-42. [PMID: 30604138 DOI: 10.1007/s11764-018-0725-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer are known to have complex medical and psychosocial needs throughout treatment; however, information is lacking about the challenges AYA survivors face after treatment has ended. Focus groups were conducted using a concept mapping framework to better understand the most important issues these patients face in transitioning to survivorship and how prepared they felt to face them. METHODS AYAs diagnosed between 18 and 39 years old and at least 2 years post-treatment participated in one of six focus groups based on age group and follow-up status. Using a concept mapping design, participants provided important issues during the transition to survivorship and appraised them on three core areas of interest. RESULTS Analyses revealed salient themes shared across age and follow-up group status, particularly related to the psychosocial, emotional, and cognitive effects of treatment. Differential concerns included those related to patients' developmental concerns-namely, finding a new identity, financial burden of treatment, and fertility concerns after treatment. CONCLUSIONS AYA cancer survivors continue to have a myriad of issues beyond the immediate treatment phase. Despite a complex list of challenges, these issues largely remained unaddressed by their oncology provider and left patients feeling overwhelmingly ill-prepared to manage their transition to survivorship. IMPLICATIONS FOR CANCER SURVIVORS AYA cancer survivors have many unaddressed concerns as they transition out of active cancer treatment, largely related to developmental issues they are facing. Survivorship care for these patients would benefit from care planning that takes these unique concerns into account.
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Affiliation(s)
- Jennifer A Hydeman
- Department of Psychology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
| | - Odochi C Uwazurike
- Survivorship and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Elizabeth I Adeyemi
- Survivorship and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.,Alabama College of Osteopathic Medicine, Dothan, AL, USA
| | - Lynda K Beaupin
- Pediatric Hematology Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.,Department of Hematology/Oncology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
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49
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Parsons HM, Penn DC, Li Q, Cress RD, Pollock BH, Malogolowkin MH, Wun T, Keegan TH. Increased clinical trial enrollment among adolescent and young adult cancer patients between 2006 and 2012-2013 in the United States. Pediatr Blood Cancer 2019; 66:e27426. [PMID: 30256525 PMCID: PMC6249090 DOI: 10.1002/pbc.27426] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Stagnant outcomes for adolescents and young adults (AYAs) 15-39 years of age with cancer are partly attributed to poor enrollment onto clinical trials. Initiatives have focused on increasing accrual, but changes at the population-level are unknown. We examined patterns of clinical trial participation over time in AYA patients with cancer. PROCEDURE We utilized medical record data from AYAs in two population-based National Cancer Institute Patterns of Care Studies identified through the Surveillance, Epidemiology and End Results Program. Among 3135 AYAs diagnosed with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma, acute lymphoblastic leukemia (ALL), and sarcoma, we used multivariate logistic regression to evaluate patient and provider characteristics associated with clinical trial enrollment. Interaction terms evaluated variation in clinical trial enrollment across patient and provider characteristics by year of diagnosis. RESULTS From 2006 to 2012-2013, clinical trial participation increased from 14.8% to 17.9% (P < 0.01). Adjusting for patient and provider characteristics, we found lower clinical trial enrollment among those who were older at diagnosis, diagnosed with NHL vs ALL, treated by adult hematologist/oncologists only (vs pediatric hematologist/oncologists), and of non-Hispanic Black race/ethnicity (vs non-Hispanic White) (P < 0.05 for all). Interaction analyses indicate improved clinical trial enrollment from 2006 to 2012-2013 among young adults 25-29 years of age and the uninsured. CONCLUSIONS Although disparities in enrollment onto clinical trials remain for AYAs with cancer, our study identified increasing overall clinical trial participation over time. Further, we identify promising trends in enrollment uptake among AYAs 25-29 years of age and the uninsured.
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Affiliation(s)
- Helen M. Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | | | - 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, CA
| | - Rosemary D. Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA
| | - Brad H. Pollock
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA
| | - Marcio H. Malogolowkin
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
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50
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Smith AW, Keegan T, Hamilton A, Lynch C, Wu XC, Schwartz SM, Kato I, Cress R, Harlan L. Understanding care and outcomes in adolescents and young adult with Cancer: A review of the AYA HOPE study. Pediatr Blood Cancer 2019; 66:e27486. [PMID: 30294882 PMCID: PMC7239374 DOI: 10.1002/pbc.27486] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 01/23/2023]
Abstract
Historically, adolescents and young adults (AYA) diagnosed with cancer have been an understudied population, and their unique care experiences, needs, and outcomes were not well understood. Thus, 10 years ago, the National Cancer Institute supported the fielding of the Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) study to address this gap. We recruited individuals diagnosed at ages 15 to 39 with germ cell, Hodgkin and non-Hodgkin lymphoma, acute lymphoblastic leukemia, and sarcoma from Surveillance, Epidemiology, and End Results cancer registries into the first multicenter population-based study of medical care, physical, and mental health outcomes for AYAs with cancer in the United States. This review of the 17 published manuscripts showed low awareness of clinical trials and substantial impact of cancer on financial burden, education and work, relationships and family planning, and physical and mental health. It highlights the feasibility of a longitudinal population-based study and key lessons learned for research on AYAs with cancer in and beyond the United States.
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Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
| | - Theresa Keegan
- UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Ann Hamilton
- Keck School of Medicine of USC, Los Angeles, California
| | | | - Xiao-Cheng Wu
- LSU Health Sciences Center School of Public Health, New Orleans, Louisiana
| | - Stephen M. Schwartz
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ikuko Kato
- Wayne State University, Detroit, Michigan
| | - Rosemary Cress
- Cancer Registry of Greater California, Sacramento, California
| | - Linda Harlan
- Special Volunteer, National Cancer Institute, Rockville, Maryland
| | - AYA HOPE Study Collaborative Group
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
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