Identifying Differences in Access to Care and Patient Outcomes of Pediatric and Adolescent Cancer Patients in the State of Georgia Open Access

Riedel, Melissa (Summer 2022)

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Intro: Children’s Oncology Group (COG) facilities across the United States have established treatment protocols for pediatric and adolescent cancer patients to receive the best care. Previous studies have identified differences in access to care and patient outcomes among this population. Adolescents are less likely to receive treatment at COG facilities compared to children. Also, patients not treated at COG facilities are noted to have worse survival outcomes.

Objective: To identify differences in access to care and patient outcomes of pediatric and adolescent cancer patients treated at COG facilities compared to other treatment centers (non-COG facilities) in the state of Georgia.

Methods: Patients aged 0 to 19 years with a reportable neoplasm diagnosed from 2009 through 2018 were identified in Georgia Cancer Registry. Chi-Square analyses compared the distribution of demographic and clinical variables by type of facility where patient received treatment. Logistic regression analyses determined if a particular cancer type would be more likely treated at a COG facility. Survival rates were calculated via Kaplan-Meier method to compare survival rates of patients seen at COG versus non-COG facilities over 5 and 10 years. Cox Proportional Hazard calculated 5-year and 10-year Hazard Ratios (HRs) of patients treated at COG versus non-COG facilities by cancer type.

Results: There were 5972 new reportable diagnoses identified in the GCR. The COG patient population consisted of half of entire adolescent population and majority of the pediatric population (86.2%). Patients with pediatric cancer types were more likely to be treated at a COG facility. Adolescents with adult cancer types were more likely to be treated elsewhere. Kaplan-Meier curves show an overall slightly higher survival probability of patients treated at non-COG facilities compared to COG facilities. With the exception of Non-Hodgkin Lymphoma (5-Year HR 0.37; 10-Year HR 0.48), none of the observed HRs were statistically significant. In addition, 5-year and 10-year HRs were generally similar.

Conclusion: Access to COG facilities for both children and adolescents has continued to improve over the last 25 years for the state of Georgia. However, survival outcomes have remained similar during this time period based on where children and adolescents receive their treatment.

Table of Contents

Chapter 1: Introduction                                                                                                     1

Chapter 2: Literature Review                                                                                            3

Chapter 3: Methods                                                                                                           11

Chapter 4: Results                                                                                                             15

Chapter 5: Discussion                                                                                                       21

Tables and Figures                                                                                                             29

References                                                                                                                           38

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