Background Rigorous processes ensure quality of research and clinical care at NCI-designated Comprehensive Cancer Centers (NCICCC). Un-measurable elements of structure and process of cancer care delivery warrant evaluation. Impact of NCICCC care on survival and access to NCICCCs for vulnerable subpopulations remains unstudied. Methods Our population-based cohort of 69,579 patients had newly-diagnosed adult-onset (22–65 years) cancers reported to the Los Angeles County (LAC) cancer registry between 1998 and 2008. Geographic Information Systems was used for geospatial analysis. Results Overall Survival Across multiple diagnoses, patients not receiving their first planned treatment at NCICCCs experienced poorer outcome compared to those treated at NCICCCs; differences persisted in multivariable analyses adjusting for clinical and sociodemographic factors (hepatobiliary [HR=1.5, 95%CI, 1.4–1.7, p<0.001]; lung [HR=1.4, 95%CI, 1.3–1.6, p<0.001]; pancreatic [HR=1.5, 95%CI, 1.3–1.7, p<0.001]; gastric [HR=1.3, 95%CI, 1.1–1.7, p=0.01]; oral [HR=1.2, 95%CI, 1.0–1.5, p=0.09]; breast [HR=1.3, 95%CI, 1.1–1.5, p<0.001]; and colorectal [HR=1.2, 95%CI, 1.0–1.4, p=0.05). Barriers to care Multivariable analyses revealed that a lower likelihood of treatment at NCICCCs was associated with: race/ethnicity (African-American: OR range across diagnoses: 0.4–0.7, p≤0.03; Hispanic: OR, 0.5–0.7, p≤0.04); lack of private insurance (public: OR, 0.6–0.8, p≤0.004; uninsured: OR, 0.1–0.5, p≤0.04); less than high SES (high-mid: OR, 0.4–0.7, p≤0.02; mid: OR, 0.3–0.5, p≤0.001; low: OR, 0.2–0.6, p≤0.01) and residing >9 miles from nearest NCICCC (OR 0.5–0.7, p≤0.02). Conclusions Among 22 to 65 year-olds with newly-diagnosed adult-onset cancer, LAC patients treated at NCICCCs experienced superior survival compared with those at non-NCICCC facilities. Barriers to care at NCICCCs included race/ethnicity, insurance, SES and distance.

Background Adolescents and young adults (AYA: 15-39y) with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) experience inferior survival when compared to children. Impact of care at NCI-designated Comprehensive Cancer Centers (CCC; or Children's Oncology Group sites [COG]) on survival disparities remains unstudied. Methods Using the Los Angeles Cancer registry, we identified 1,870 ALL or AML patients between 1 and 39y at diagnosis. Cox regression analyses assessed risk of mortality; younger age+CCC/COG served as the referent group. Logistic regression was used to determine odds of care at CCC/COG, adjusting for variables above. Results ALL outcome: AYAs at non-CCC/COG experienced inferior survival (15-21y: HR=1.9, p=0.005; 22-29y: HR=2.6, p<0.001; 30-39y: HR=3.0, p<0.001). Outcome at CCC/COG was comparable between children and young AYAs (15-21y: HR=1.3, p=0.3; 22-29y: HR=1.2, p=0.2) but was inferior for 30-39yo (HR=3.4, p<0.001). AML outcome: AYAs at non-CCC/COG experienced inferior outcome (15-21y: HR=1.8, p=0.02; 22-39y: HR=1.4, p=0.06). Outcome at CCC/COG was comparable between children and 15-21yo (HR=1.3, p=0.4) but was inferior for 22-39yo (HR=1.7, p=0.05). Access: 15-21yo were less likely to use CCC/COG than children (p<0.001). In 22-39yo, public/uninsured (ALL: p=0.004; AML<0.001), African-American/Hispanics (ALL: p=0.03), and 30-39yo (ALL: p=0.03) were less likely to use CCC/COG. Conclusions Poor survival in AYAs with ALL and AML is mitigated by care at CCC/COG. Barriers to CCC/COG care include public/uninsured, and African-American/Hispanic race/ethnicity. Impact Care at CCC/COG explains, in part, inferior outcomes in AYAs with ALL and AML. Key sociodemographic factors serve as barriers to care at specialized centers.

Population-based data reveal that care at NCICCC/COG sites mitigates inferior outcome in AYAs with WHO grade II CNS tumors compared with children. Compared with children, AYAs are less likely to receive care at NCICCC/COGs. Insurance, socioeconomic status, and distance serve as barriers to care at NCICCCs for older AYAs.

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Background: AYA (15-39y) diagnosed with hematologic malignancies have inferior survival and have not seen the same survival improvement in comparison with those diagnosed during childhood (0-14y) leaving an AYA Gap. Treatment on pediatric trials is associated with superior survival in 15-21y diagnosed with acute lymphoblastic leukemia (ALL). However, impact of care at National Cancer Institute-designated Comprehensive Cancer Centers (NCICCC) for AYA of all ages or Children’s Oncology Group sites (COG) for AYA aged 15-21y remains unstudied. Methods: We constructed a population-based cohort of 1,388 children (1-14y), 673 young AYA (15-21y) and 2,275 older AYA (22-39y) with newly diagnosed ALL, acute myeloid leukemia (AML), Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) reported to the LA County cancer registry between 1998-2008. We sought to determine the impact of care at NCICCC/COG (NCICCC+COG: n=3, COG: n=3) on overall survival (OS) and barriers to access to care at NCICCC/COG in AYA with hematologic malignancies. Multivariable Cox regression was used to derive hazard ratios (HR) for mortality, adjusting for gender, race/ethnicity, socioeconomic status (SES) [and stage in lymphomas]. Multivariable logistic regression was used to derive odds ratios (OR) for likelihood of care at NCICCC/COG, adjusting for above variables plus insurance and distance to the nearest NCICCC/COG. Distance to NCICCC/COG was derived using Geographic Information Systems. Results: AYA experienced inferior 5y OS as compared to children across diagnoses (Figure: ALL [n=1,380]: 72% [10-14y] vs 44% [15-21y] vs 38% [22-39y], p<0.01; AML [n=490]: 63% [1-14y] vs 49% [15-21y] vs 49% [22-39y], p<0.01; NHL [n=1,379] : 86% [1-14y] vs 78% [15-21y] vs 68% [22-39y], p<0.01; HL [n=1,087]: 96% [1-14y] vs 95% [15-21y] vs 90% [22-39y], p=0.04). AYA with ALL treated at community sites had worse outcome when compared with children (15-21y vs 10-14y: HR=2.9, p<0.01; 22-39y vs 10-14y: HR=4.7, p<0.01). This difference in outcome between young AYA and children with ALL was abrogated by care at NCICCC/COG (HR=1.3, p=0.2) and greatly diminished in older AYA by care at NCICCC (HR=2.5, p<0.01). Similarly, AYA with AML treated at community sites had worse outcome when compared with children (15-21y vs 1-14y: HR=2.3, p<0.01; 22-39y vs 1-14y: 1.8, p=0.07). The difference in outcome was abrogated by care at NCICCC/COG (young AYA vs children with AML: HR=1.1, p=0.07; older AYA vs children: HR=1.5, p=0.2). AYA with NHL treated at community sites had worse outcome as compared to children (15-21y vs 1-14y: HR=2.4, p=0.04; 22-39y vs 1-14y: HR=3.9, p<0.01). The difference in outcome was diminished by care at NCICCC/COG (young AYA vs children with NHL: HR=2.0, p=0.06; older AYA vs children: HR=1.6, p=0.2). Compared to children and young AYA (1-21y) with HL, older AYA cared for at community sites had poor outcome (HR=2.2, p<0.01). The difference between older AYA and younger patients (1-21y) was mitigated by care at NCICCC (HR=1.2, p=0.6). While 69% of children were treated at one of NCICCC/COG sites in LA County, only 38% of young AYA were seen at NCICCC/COG and merely 10% of older AYA were seen at NCICCCs. Compared with children (0-14y), young AYA (15-21y) were less likely to receive care at NCICCC/COG (ALL: OR=0.5; AML: OR=0.2; NHL: OR=0.3; HL: OR=0.2; all p<0.01), irrespective of SES, distance to care, insurance status. In analyses restricted to older AYA (22-39y), public or no insurance (ALL: OR=0.1; AML: OR=0.2; NHL: OR=0.3, all p<0.01), African-American or Hispanic background (HL: OR=0.3, p<0.01), low SES (NHL: OR=0.5, p<0.01) and distance from the nearest NCICCC (NHL: OR=0.5; HL: OR=0.5, all p<0.01) reduced likelihood of receiving care at NCICCC. Conclusions: Population-based data reveal that receipt of care at NCICCC/COG greatly diminishes the inferior outcome in AYA with hematologic malignancies. The role that cancer biology, therapeutic strategy and treating physician specialty (pediatric vs adult) each play in this dynamic is currently under investigation. Irrespective of all sociodemographic variables, young AYA are less likely to use NCICCC/COG than children. Among older AYA, patients without private insurance, from low SES, African-American/ Hispanic backgrounds or living >9 miles from the nearest NCICCC are less likely to receive treatment at NCICCC. Barriers to care at COG/NCICCC are currently being explored. Figure 1 Figure 1. Disclosures Stock: Jazz Pharmaceuticals: Consultancy; Amgen: Consultancy; Seattle Genetics: Consultancy; Sigma Tau: Consultancy; Sigma Tau: Research Funding.