Increased clinical trial enrollment among adolescent and young adult cancer patients between 2006 and 2012–2013 in the United States

Parsons, Helen; Penn, Dolly C.; Li, Qian; Cress, Rosemary D.; Pollock, Bradley H; Malogolowkin, Marcio H.; Wun, Theodore; Keegan, Theresa H.M.

doi:10.1002/pbc.27426

Cited by 43 publications

(50 citation statements)

References 23 publications

(77 reference statements)

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“…They also found promising trends in patients aged 25 to 29 years, who doubled their enrollment from 6.3% in 2006 to 13.2% in 2012 and 2013. In addition, the authors noted a decrease in uninsured patients and improved trial enrollment among those who were uninsured, from 5.7% in 2006 to 12.8% in 2012 and 2013 …”

Section: Improving Outcomes Of Ayas With Cancermentioning

confidence: 96%

Adolescent and young adult oncology—past, present, and future

Dreyzin

Miller

et al. 2019

CA A Cancer J Clinicians

163

114

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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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Section: Improving Outcomes Of Ayas With Cancermentioning

confidence: 96%

Adolescent and young adult oncology—past, present, and future

Dreyzin

Miller

et al. 2019

CA A Cancer J Clinicians

163

114

View full text Add to dashboard Cite

show abstract

“…The lack of enrollment of specific patient populations in CCTs prevents the determination of optimal treatment regimens and the collection of essential biospecimens needed to target the underlying disease biology in future studies. AYA enrollment in CCTs has significantly lagged behind the enrollment of pediatric patients . Enrollment is estimated to range between 3% and 14% for all AYAs, but enrollment rates vary within the AYA population .…”

Section: Introductionmentioning

confidence: 99%

“…AYA enrollment in CCTs has significantly lagged behind the enrollment of pediatric patients . Enrollment is estimated to range between 3% and 14% for all AYAs, but enrollment rates vary within the AYA population . Previous research has consistently found higher enrollment rates in adolescent patients than patients in their 20s and 30s …”

Section: Introductionmentioning

confidence: 99%

Systematic review of barriers and facilitators to clinical trial enrollment among adolescents and young adults with cancer: Identifying opportunities for intervention

Siembida

Loomans-Kropp

Trivedi

et al. 2019

Cancer

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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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“…In addition, hematopoietic stem cell transplantation (HSCT) is less used in pediatric trials . Other factors contributing to the differences between the two types of trials relate to the greater experience observed in pediatric centers and higher adherence of AYA treated in pediatric vs adult cancer centers in some countries . However, a recently published study by three adult US cooperative groups (CALGB, ECOG, and SWOG) demonstrated that the use of a full pediatric regimen for young adults (YA) with ALL up to the age of 40 years was feasible and effective, resulting in improved survival rates compared to historical controls …”

Section: Introductionmentioning

confidence: 99%

A pediatric regimen for adolescents and young adults with Philadelphia chromosome‐negative acute lymphoblastic leukemia: Results of the ALLRE08 PETHEMA trial

et al. 2020

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Background Pediatric‐based or ‐inspired trials have improved the prognosis of adolescents and young adults (AYA) with Philadelphia chromosome‐negative (Ph‐neg) acute lymphoblastic leukemia (ALL). Methods This study reports the results of treatment of the ALLRE08 trial, a full pediatric trial for AYA aged 15‐30 years with standard‐risk (SR) ALL. Results From 2008 to 2018, 89 patients (38 adolescents [15‐18 years] and 51 young adults [YA, 19‐30 years], median age: 20 [15‐29] years) were enrolled in the ALLRE08 trial. The complete response (CR) was 95%. Twenty‐two patients were transferred to a high‐risk (HR) protocol because of poor marrow response on day 14 (n = 20) or high‐level of end‐induction minimal residual response (MRD ≥ 0.25%, n = 2). Cumulative incidence of relapse (CIR) at 5 years was 35% (95%CI: 23%‐47%), with significant differences between adolescents and YA: 13% (4%‐28%) vs 52% (34%‐67%), P = .012. No treatment‐related mortality was observed in 66/66 patients following the ALLRE08 trial vs 3/23 patients moved to a HR trial. The estimated 5‐year overall survival (OS) was 74% (95%CI: 63%‐85%), with significantly higher rates for adolescents vs YA: 87% (95%CI: 74%‐100%) vs 63% (46%‐80%), P = .021. Although CIR or OS were lower in patients who were transferred to a HR trial, the differences were not statistically significant (CIR: 34% [21%‐47%] vs 37% [14%‐61%]; OS: 78% [66%‐90%] vs 61% [31%;91%]). Conclusion A full pediatric trial is feasible and effective for AYA with Ph‐neg, SR‐ALL, with better results for adolescents than for YA. Outcome of patients with poor early response rescued with a HR trial was not significantly inferior.

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Increased clinical trial enrollment among adolescent and young adult cancer patients between 2006 and 2012–2013 in the United States

Abstract: 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.

Cited by 43 publications

References 23 publications

Adolescent and young adult oncology—past, present, and future

Adolescent and young adult oncology—past, present, and future

Systematic review of barriers and facilitators to clinical trial enrollment among adolescents and young adults with cancer: Identifying opportunities for intervention

A pediatric regimen for adolescents and young adults with Philadelphia chromosome‐negative acute lymphoblastic leukemia: Results of the ALLRE08 PETHEMA trial

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