September 10, 2014 | by City of Hope Staff
Older teenagers and young adults traditionally face worse outcomes than younger children when diagnosed with brain cancer and other central nervous system tumors. A first-of-its-kind study shows why.
A team of researchers from the departments of Population Sciences and Pathology at City of Hope recently examined the cancer registry, looking at the entire Los Angeles County population of older adolescents and young adults — collectively known as AYAs — and children diagnosed with central nervous system (CNS) cancers, which include tumors of the brain and spinal cord.
The study included nearly 1,350 patients: children 14 years old and under and AYAs, who fall between the ages of 15 and 39. The National Cancer Institute (NCI) has determined that AYA patients form a special group because of unique challenges they face in cancer treatment, and this study was the first to assess the impact on survival of where an AYA patient receives care.
The scientists, led by Julie Wolfson, M.D., M.S.H.S., assistant professor, and Smita Bhatia, M.D., M.P.H., the Ruth Ziegler Chair in Population Sciences, found that both children and AYAs with a select group of CNS tumors who were treated at NCI-designated comprehensive cancer centers such as City of Hope fared better than those seeking care at adult community facilities. In some cases, the difference in five-year survival rates was more than 10 percent. Of special note, the AYAs with these cancers fared worse than the children, but by receiving care at an NCI-designated comprehensive cancer center, this difference was wiped away.
In short, it matters where these patients receive care, and centers that offer specialized care addressing their needs provide better outcomes overall for AYAs and children with CNS cancers.
Unfortunately, AYAs are less likely than younger children to seek care at a comprehensive cancer center, particularly if they are over 22 years old with low socioeconomic status, if they have no insurance or public insurance, or if they live more than five miles from the nearest center. This points to a need to expand access to high-quality, multidisciplinary care that addresses the needs of AYAs.
“AYAs with cancer have not seen the same improvement in survival that children have, and are not treated at specialty cancer centers as often,” Wolfson said. “Now we see that, at least in one type of cancer, treatment at a specialty center can overcome these poor outcomes in AYAs and we have a sense as to what prevents them from getting that care. Ongoing changes in the delivery of health care have been increasing coverage in AYAs, but the changing pattern of benefits and coverage may be adding another barrier to receiving care at specialty cancer centers.”
The researchers suggest future studies that aim to find ways to improve outcomes for AYAs should look at the barriers keeping these patients away from specialized care, as well as ways to overcome those barriers.
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under grant numbers K12 CA001727 and P30CA33572. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The study was also supported by funds from the St. Baldrick’s Foundation.
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