Impact of Treatment Site in Adolescents and Young Adults With Central Nervous System Tumors

Wolfson, Julie; Sun, Can‐Lan; Kang, Tongjun; Wyatt, Laura; D’Appuzzo, Massimo; Bhatia, Smita

doi:10.1093/jnci/dju166

Cited by 53 publications

(65 citation statements)

References 15 publications

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“…Distance has been associated with care at CCC/COG sites in older AYAs in Los Angeles County with central nervous system tumors(30) and adult-onset tumors,(31) thus these findings in ALL and AML could reflect a lower level of comfort among non-CCC/COG facilities to treat acute leukemia, including a need for higher intensity supportive care; these aspects were examined employing NCI designation as a surrogate. It is conceivable that distance is less of a factor in this study due examination of a single county, which would limit the generalizability of these findings across the U.S.; however Los Angeles County spans 4,751 square miles and was home to 9.8 million people in 2008.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously published our observations for other cancer diagnoses, and found that health coverage predicts treatment site. (30) Thus in the current study, we have grouped patients with comparable access to public coverage; 15-21 year-olds at a site designated as COG for pediatrics (but not as CCC), were assigned to COG. Repeating analyses without inclusion of the 3 COG sites that were not affiliated with an NCI-designated CCC yielded comparable findings.…”

Section: Discussionmentioning

confidence: 99%

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Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Wolfson

Sun

Wyatt

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Wolfson

Sun

Wyatt

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…How to apply the statistically significant, yet modest difference in absolute distance between groups to other counties will vary; LAC has more NCICCCs than most states, and is physically challenging to navigate with 9 miles representing a transportation challenge and time commitment distinct from other regions, as presented in other distance evaluations. 18,30 Studying LAC alone provides a geographic and sociodemographic landscape with a robust multi-ethnic population, 3 NCICCCs within 4,752 square miles spanning rural and urban areas, and a population that would rank as the eighth most populous state.…”

Section: Discussionmentioning

confidence: 99%

Impact of care at comprehensive cancer centers on outcome: Results from a population‐based study

Wolfson

Sun

Wyatt

et al. 2015

Cancer

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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.

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“…35,36 As a result, AYA survivors may lack access to survivor-focused supportive care services that promote healthy nutrition and exercise. Findings in the literature are mixed as to whether AYA survivors' engagement in health behaviors is worse or better than that of their healthy peers.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions

McClellan

et al. 2015

Journal of Adolescent and Young Adult Oncology

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Purpose: This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18-39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters. Methods: Survivors (M age = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a selfreported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating. Results: In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support). Conclusion: AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.

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Impact of Treatment Site in Adolescents and Young Adults With Central Nervous System Tumors

Cited by 53 publications

References 15 publications

Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Adolescents and Young Adults with Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: Impact of Care at Specialized Cancer Centers on Survival Outcome

Impact of care at comprehensive cancer centers on outcome: Results from a population‐based study

Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions

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