Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group

Survival Trends Among Adolescents and Young Adults Diagnosed With Cancer in the United States: Comparisons With Children and Older Adults

“…46 National Comprehensive Cancer Network guidelines suggest that AYAs with breast cancer, especially those with locally advanced and metastatic diseases, be referred to tertiary/specialized cancer centers where clinical trials are offered, so they can be managed according to the tumor stage and tumor biology rather than on the basis of age at diagnosis. 49,50 Survival has been reported to be improved at specialized cancer centers for many cancer types, 23,[26][27][28][29][30][31] providing further evidence that such centers have the potential to enhance outcomes in this population.…”

“…17,18,[20][21][22] Efforts have also recognized the importance of health insurance to improve access to care and the need for AYAs to receive treatment in specialized cancer centers for certain cancers. [23][24][25][26][27][28][29][30][31] In particular, the Affordable Care Act has increased insurance coverage for AYAs, who were historically the most highly uninsured population in the United States. 20,[32][33][34] Health insurance is important not only for early-stage diagnosis and cancer treatment but also for long-term cancer survivorship care.…”

“…20,[32][33][34] Health insurance is important not only for early-stage diagnosis and cancer treatment but also for long-term cancer survivorship care. 23,24,[35][36][37] Despite this overall progress, studies have also shown that improvements are not uniform across all AYAs but rather vary by cancer type, stage at diagnosis, and sociodemographic factors, including race/ethnicity, sex, and socioeconomic status. 8,17,38 When considering specific cancers, AYAs with ALL, AML, myeloma, Ewing sarcoma (soft tissue), liver, pancreatic, and lung cancers had substantial improvements in survival (AAC in survival of >1.0%).…”

“…These survival differences have been noted previously and may relate, in part, to the unique biologic/genomic characteristics of AYA cancers, not completing the planned treatment, as well as reduced access to appropriate cancer treatment, supportive care for treatment-related toxicities, and long-term survivorship care. 17,18,23,26,41,42 In addition, children had superior 5-year relative survival than AYAs for distant stage NHL, HL, osteosarcoma, Ewing sarcoma (bone), and STS. While there have been improvements in survival for most cancers, there was no improvement in survival observed for AYAs with osteosarcoma over time.…”

Children's Oncology Group 2023 blueprint for research: Adolescent and young adult oncology

“…Additional details describing the strategic approach to expand the AYA cancer care delivery portfolio is in the report titled “Reducing adolescent and young adult cancer outcome disparities through optimized care delivery: A blueprint from the Children's Oncology Group.” 30 …”