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Nakata K, Okawa S, Fuji S, Sato A, Morishima T, Tada Y, Inoue M, Hara J, Kawa K, Miyashiro I. Trends in survival of leukemia among children, adolescents, and young adults: A population-based study in Osaka, Japan. Cancer Sci 2021; 112:1150-1160. [PMID: 33428808 PMCID: PMC7935797 DOI: 10.1111/cas.14808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
This study focused on children as well as adolescents and young adults (AYAs) and aimed to examine trends in survival of leukemia over time using population-based cancer registry data from Osaka, Japan. The study subjects comprised 2254 children (0-14 years) and 2,905 AYAs (15-39 years) who were diagnosed with leukemia during 1975-2011. Leukemia was divided into four types: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and other leukemias. We analyzed 5-year overall survival probability (5y-OS), using the Kaplan-Meier method and expressed time trends using the joinpoint regression model. For recently diagnosed (2006-2011) patients, a Cox proportional hazards model was applied to determine predictors of 5y-OS, using age group, gender, and treatment hospital as covariates. Over the 37-year period, 5y-OS greatly improved among both children and AYAs, for each leukemia type. Among AYAs, 5y-OS of ALL improved, especially after 2000 (65% in 2006-2011), when the pediatric regimen was introduced but was still lower than that among children (87% in 2006-2011, P < .001). Survival improvement was most remarkable in CML, and its 5y-OS was over 90% among both children and AYAs after the introduction of molecularly targeted therapy with tyrosine kinase inhibitors. Among patients with recently diagnosed AML, the risk of death was significantly higher for patients treated at nondesignated hospitals than those treated at designated cancer care hospitals. The changes in survival improvement coincided with the introduction of treatment regimens or molecularly targeted therapies. Patient centralization might be one option which would improve survival.
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Affiliation(s)
- Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Sato
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Yuma Tada
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan
| | - Masami Inoue
- Department of Hematology/ Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Junichi Hara
- Department of Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka, Japan
| | - Keisei Kawa
- Department of Hematology/ Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Palliative Care in Adolescents and Young Adults With Cancer-Why Do Adolescents Need Special Attention? Cancer J 2018; 24:336-341. [PMID: 30480579 DOI: 10.1097/ppo.0000000000000341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Meeting shortfalls in the provision of care to adolescents and young adults with cancer has focused largely on improving outcomes and psychosocial support. A significant percentage of adolescents and young adults with cancer will die of disease because of initial poor prognosis conditions or disease relapse. In adults, progress has been made in the concept of an integrated cancer/palliative care service. In pediatric oncology, the application of this philosophy of care has lagged behind somewhat. In the case of adolescents, particularly those with advanced cancer, the palliative care needs, in a broader sense than only end-of-life care, are often not adequately met, irrespective of whether treatment is delivered in a pediatric or adult cancer service. There are a number of age-specific aspects to palliative and supportive care for adolescents. Complex interactions between clinicians, parents, and patients potentially limit the young person's ability to influence care planning. The wide variation in real or perceived competency at this age, the developmental challenges in relation to behavior, communication, and coping strategy all require particular professional expertise that is not always available.
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White VM, Skaczkowski G, Pinkerton R, Coory M, Osborn M, Bibby H, Nicholls W, Orme LM, Conyers R, Phillips MB, Harrup R, Walker R, Thompson K, Anazodo A. Clinical management of Australian adolescents and young adults with acute lymphoblastic and myeloid leukemias: A national population-based study. Pediatr Blood Cancer 2018; 65:e27349. [PMID: 30039912 DOI: 10.1002/pbc.27349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND While several studies have examined the treatment of adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), studies of acute myeloid leukemia (AML) are rare. Using national data for Australia, we describe (i) the number and type of treatment centers caring for AYAs, (ii) induction/first-line treatments, and (iii) survival outcomes. PROCEDURE National population-based study assessing treatment of 15- to 24-year-olds diagnosed with ALL or AML between 2007 and 2012. Treatment details were abstracted from hospital medical records. Treatment centers were classified as pediatric or adult (adult AYA-focused or other adult; and by AYA volume [high/low]). Cox proportional hazard regression analyses examined associations between treatment and overall, event-free, and relapse-free survival outcomes. RESULTS Forty-seven hospitals delivered induction therapy to 351 patients (181 ALL and 170 AML), with 74 (21%) treated at pediatric centers; 70% of hospitals treated less than two AYA leukemia patients per year. Regardless of treatment center, 82% of ALL patients were on pediatric protocols. For AML, pediatric protocols were not used in adult centers, with adult centers using a non-COG 7+3-type induction protocol (51%, where COG is Cooperative Oncology Group) or an ICE-type protocol (39%, where ICE is idarubicin, cytarabine, etoposide). Exploratory analyses suggested that for both ALL and AML, AYAs selected for adult protocols have worse overall, event-free, and relapse-free survival outcomes. CONCLUSIONS Pediatric protocols were commonly used for ALL patients regardless of where they are treated, indicating rapid assimilation of recent evidence by Australian hematologists. For AML, pediatric protocols were only used at pediatric centers. Further investigation is warranted to determine the optimal treatment approach for AYA AML patients.
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Affiliation(s)
- V M White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - G Skaczkowski
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - R Pinkerton
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - M Coory
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Osborn
- Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - H Bibby
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - W Nicholls
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - L M Orme
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - R Conyers
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M B Phillips
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - R Harrup
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - R Walker
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
| | - K Thompson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
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Pulte D, Castro FA, Brenner H, Jansen L. Outcome disparities by insurance type for patients with acute myeloblastic leukemia. Leuk Res 2017; 56:75-81. [DOI: 10.1016/j.leukres.2017.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
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White V, Daly C, Anazodo A, Bibby H, Orme LM, Pinkerton R, Pole JD, Thompson K, Nathan PC, Baxter NN, Gupta S. The Australian-Canadian Adolescent and Young Adult Collaborative Cohort Initiative: Initial Meeting Report. J Adolesc Young Adult Oncol 2016; 6:1-5. [PMID: 27564221 DOI: 10.1089/jayao.2016.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victoria White
- 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria , Melbourne, Australia
| | - Corinne Daly
- 2 Department of Surgery, Li Ki Shing Knowledge Institute , St. Michael's Hospital, Toronto, Ontario, Canada
| | - Antoinette Anazodo
- 3 Kids Cancer Centre, Sydney Children's Hospital , Randwick, New South Wales, Australia .,4 Nulune Comprehensive Cancer Centre, Bright Alliance, Prince of Wales Hospital , Randwick, New South Wales, Australia
| | - Helen Bibby
- 1 Centre for Behavioural Research in Cancer, Cancer Council Victoria , Melbourne, Australia
| | - Lisa M Orme
- 5 Children's Cancer Centre, Royal Children's Hospital , Melbourne, Victoria, Australia .,6 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Ross Pinkerton
- 7 Children's Health Queensland Hospital and Health Service , Brisbane, Queensland, Australia
| | - Jason D Pole
- 8 Pediatric Oncology Group of Ontario , Toronto, Ontario, Canada .,9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada
| | - Kate Thompson
- 6 Peter MacCallum Cancer Centre , Melbourne, Victoria, Australia
| | - Paul C Nathan
- 9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,10 Division of Haematology/Oncology, The Hospital for Sick Children , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
| | - Nancy N Baxter
- 2 Department of Surgery, Li Ki Shing Knowledge Institute , St. Michael's Hospital, Toronto, Ontario, Canada .,9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
| | - Sumit Gupta
- 9 Cancer Research Program, Institute for Clinical Evaluative Sciences , Toronto, Ontario, Canada .,10 Division of Haematology/Oncology, The Hospital for Sick Children , Toronto, Ontario, Canada .,11 Institute for Health Policy, Evaluation and Management, University of Toronto , Toronto, Ontario, Canada
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Pulte D, Jansen L, Castro FA, Krilaviciute A, Katalinic A, Barnes B, Ressing M, Holleczek B, Luttmann S, Brenner H. Survival in patients with acute myeloblastic leukemia in Germany and the United States: Major differences in survival in young adults. Int J Cancer 2016; 139:1289-96. [DOI: 10.1002/ijc.30186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/20/2016] [Accepted: 04/29/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Dianne Pulte
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Felipe A. Castro
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center (DKFZ); Heidelberg Germany
| | - Agne Krilaviciute
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center (DKFZ); Heidelberg Germany
| | | | - Benjamin Barnes
- National Center for Cancer Registry Data, Robert Koch Institute; Berlin Germany
| | - Meike Ressing
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Centre, Mainz, Germany, Johannes Gutenberg University; Mainz
- Cancer Registry Rhineland-Palatinate; Mainz Germany
| | | | - Sabine Luttmann
- Bremen Cancer Registry, Leibniz-Institute for Prevention Research and Epidemiology-BIPS; Bremen Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center (DKFZ); Heidelberg Germany
- Division of Preventive Oncology; German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT); Heidelberg Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ); Heidelberg Germany
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Nakata-Yamada K, Inoue M, Ioka A, Ito Y, Tabuchi T, Miyashiro I, Masaie H, Ishikawa J, Hino M, Tsukuma H. Comparison of survival of adolescents and young adults with hematologic malignancies in Osaka, Japan. Leuk Lymphoma 2015; 57:1342-8. [PMID: 26695739 DOI: 10.3109/10428194.2015.1083562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The survival gap between adolescents and young adults (AYAs) with hematological malignancies persists in many countries. To determine to what extent it does in Japan, we investigated survival and treatment regimens in 211 Japanese AYAs (15-29 years) in the Osaka Cancer Registry diagnosed during 2001-2005 with hematological malignancies, and compared adolescents (15-19 years) with young adults (20-29 years). AYAs with acute lymphoblastic leukemia (ALL) had a poor 5-year survival (44%), particularly young adults (29% vs. 64% in adolescents, p = 0.01). Additional investigation for patients with ALL revealed that only 19% of young adults were treated with pediatric treatment regimens compared with 45% of adolescents (p = 0.05). Our data indicate that we need to focus on young adults with ALL and to consider establishing appropriate cancer care system and guidelines for them in Japan.
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Affiliation(s)
- Kayo Nakata-Yamada
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Masami Inoue
- b Department of Hematology/Oncology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan
| | - Akiko Ioka
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Yuri Ito
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Takahiro Tabuchi
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Isao Miyashiro
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Hiroaki Masaie
- c Department of Hematology/Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Jun Ishikawa
- c Department of Hematology/Oncology , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - Masayuki Hino
- d Department of Hematology , Graduate School of Medicine, Osaka City University , Osaka , Japan
| | - Hideaki Tsukuma
- a Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
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Tai E, Buchanan N, Westervelt L, Elimam D, Lawvere S. Treatment setting, clinical trial enrollment, and subsequent outcomes among adolescents with cancer: a literature review. Pediatrics 2014; 133 Suppl 3:S91-7. [PMID: 24918213 PMCID: PMC6075704 DOI: 10.1542/peds.2014-0122c] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There has been an overall improvement in survival rates for persons with cancer over the past 35 years. However, these gains are less prevalent among adolescents with cancer aged 15 to 19 years, which may be due to lower clinical trial enrollment among adolescents with cancer. METHODS We conducted a literature review to assess current research regarding clinical trial enrollment and subsequent outcomes among adolescents with cancer. The search included English-language publications that reported original data from January 1985 to October 2011. RESULTS The search identified 539 records. Of these 539 records, there were 30 relevant original research articles. Multiple studies reported that adolescents with cancer are enrolled in clinical trials at lower rates compared with younger children and older adults. Treatment setting, physician type, and institution type may all be factors in the low enrollment rate among adolescents. Few data focused solely on adolescents, with many studies combining adolescents with young adults. The number of available studies related to this topic was limited, with significant variability in study design, methods, and outcomes. CONCLUSIONS This literature review suggests that adolescents with cancer are not treated at optimal settings and are enrolled in clinical trials at low rates. This may lead to inferior treatment and poor subsequent medical and psychosocial outcomes. The scarcity in data further validates the need for additional research focusing on this population.
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Affiliation(s)
- Eric Tai
- Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | | | - Dena Elimam
- SciMetrika LLC, Research Triangle Park, North Carolina
| | - Silvana Lawvere
- Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
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Osborn M, Little C, Bowering S, Orme L. Youth Cancer Services in Australia: Development and Implementation. International Perspectives on AYAO, Part 3. J Adolesc Young Adult Oncol 2013; 2:118-24. [DOI: 10.1089/jayao.2012.0032] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Osborn
- Youth Cancer Service South Australia/Northern Territory, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | | | - Sharon Bowering
- Youth Cancer Service South Australia/Northern Territory, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Lisa Orme
- ONTrac at Peter Mac, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Dokmanovic L, Krstovski N, Vukanic D, Brasanac D, Rodic P, Cvetkovic M, Janic D. Pediatric non-Hodgkin lymphoma: a retrospective 14-year experience with Berlin-Frankfurt-Münster (BFM) protocols from a tertiary care hospital in Serbia. Pediatr Hematol Oncol 2012; 29:109-18. [PMID: 22376014 DOI: 10.3109/08880018.2011.652342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Use of current intensive chemotherapy protocols in pediatric non-Hodgkin lymphoma (NHL) in high-income countries resulted in event-free survival (EFS) rates ranging from 80 to 90%. The results are inferior in less privileged countries with limited resources for medical care. There are no reports about comprehensive data analysis in pediatric NHL in Serbia. A retrospective study was carried out at University Children's Hospital, Belgrade, in children aged less than 18 years diagnosed with non-Hodgkin lymphoma from 1997 to 2011. Fifty-seven children were eligible for analysis. Fourteen were diagnosed with lymphoblastic lymphoma, 38 with mature B-cell NHL (B-NHL), and 5 with anaplastic large-cell lymphoma. Mean age at diagnosis was 9.2 years, with male to female ratio 2.35:1. Children were treated according to Berlin-Frankfurt-Münster (BFM) protocols. With median follow-up of 59.3 months, 5-year probability of EFS was 84.1% for all patients, whereas overall survival was 93%. These results with BFM protocol administration, although inferior to leading international groups, reflect good treatment outcome in our patients. To the best of the authors' knowledge, this article presents the first results regarding treatment and survival of childhood NHL in Serbia.
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Affiliation(s)
- Lidija Dokmanovic
- Department of Hematology/Oncology, University Children's Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
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