Outcomes of Cancer Treatment for Rare Pediatric Tumors in an Adolescent and Young Adult (AYA) Population in the State of Georgia Open Access

Cash, William Thomas (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/ws859g45s?locale=en
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Abstract

Adolescent and young adult (AYA) patients with cancer have not experienced the same improvement in survival as that seen in younger or older patients. Part of the challenge in managing these patients is deciding where and how they should be treated for their malignancy. This is especially difficult for patients in late adolescence or very early adulthood (15-21 years) who have an adult-type malignancy, such as a carcinoma or a melanoma, which is rarely seen in pediatrics. We performed a retrospective analysis using the Georgia Cancer Registry (GCR) of 15-21-year-old patients with a malignant, rare pediatric tumor diagnosed during the 10 year period from 2000-2009. Patients were identified as being treated at one of five Georgia pediatric cancer centers or at an adult center. Data were analyzed for 10-year overall survival, patient characteristics associated with death, and characteristics present at diagnosis that influenced the choice of treatment center. There was a total of 479 patients in our final study population, of which 379(79.1%) were treated at an adult center and 100(20.9%) were treated at a pediatric center. Patients treated at an adult center had a 10-year overall survival of 86% compared to 85% for patients treated at a pediatric center (log-rank p-value= 0.31). Patients with thyroid carcinoma had a decreased hazard ratio (HR) for death compared to those with melanoma (HR=0.052; 95% CI=0.007-0.409). Patients with regional (HR=4.660; 95% CI=2.065-10.516) and distant (HR=20.967; 95% CI=7.728-56.891) stage disease were more likely to die than those with local stage disease. Race and poverty status were not significantly associated with death. Older (19-21 years) patients were less likely to be treated at a pediatric center (OR=0.219; 95% CI=0.129-0.371). Those with nasopharyngeal (OR=7.384; 95% CI=2.295-23.754) and other (OR=2.643; 95% CI=1.248-5.598) carcinomas were more likely to be treated at a pediatric center. Patients with distant stage (OR=4.242; 95% CI=1.710-10.520) and higher poverty (OR=2.316; 95% CI=1.229-4.365) were also more likely to be treated at a pediatric center. Our data suggests that there is no difference in survival for 15-21 year old patients with rare pediatric tumors when treated at an adult or a pediatric center.

Table of Contents

Table of Contents

1. Introduction……………………………………………………………..1

2. Background……………………………………………………………..3

3. Methods…………………………………………………………………6

4. Results…………………………………………………………………..11

5. Discussion………………………………………………………………16

6. References………………………………………………………………22

7. Tables/Figures…………………………………………………………..25

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