Clinical Trial Participation and Time to Treatment Among Adolescents and Young Adults With Cancer: Does Age at Diagnosis or Insurance Make a Difference?
Clinical Trial Participation and Time to Treatment Among Adolescents and Young Adults With Cancer: Does Age at Diagnosis or Insurance Make a Difference?
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DOI：
10.1200/jco.2011.36.2954
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发表时间：
2011-10-20
影响因子：
45.3
通讯作者：
Keegan, Theresa H. M.
中科院分区：
文献类型：
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作者：
Parsons, Helen M.;Harlan, Linda C.;Keegan, Theresa H. M.
由于青少年和年轻成人（AYA）癌症患者在过去的二十年中经历了不同程度的生存改善，因此提高这一人群癌症护理的质量和及时性已成为优先领域。为了确定目前的趋势，在AYA护理，我们研究了模式的临床试验参与，治疗时间，并提供者的特点，在人口为基础的样本的AYA患者cancer.MethodsUsing护理研究的国家癌症研究所模式，我们使用多变量逻辑回归，以评估人口统计学和提供者的特点与临床试验登记和治疗时间之间的1，358名AYA癌症患者（年龄15至39岁）确定通过监测，流行病学，和最终结果Program.ResultsIn我们的研究，14%的患者年龄15至39岁已登记进入临床试验;参与情况因癌症类型而异，被诊断为急性淋巴细胞白血病（37%）和肉瘤（32%）的参与率最高。多变量分析表明，没有保险的老年患者和非儿科肿瘤学家治疗的患者不太可能参加临床试验。从病理确诊到首次治疗的中位时间为3天，但这因人种/种族和癌症部位而异。在多变量分析，先进的癌症阶段和门诊治疗单独与较长的时间从病理证实treatment.ConclusionOur研究确定的因素与低的临床试验参与AYA癌症患者。这些发现支持继续需要改善这一人群的临床试验和创新治疗，这可能最终转化为改善生存率。
PurposeBecause adolescent and young adult (AYA) patients with cancer have experienced variable improvement in survival over the past two decades, enhancing the quality and timeliness of cancer care in this population has emerged as a priority area. To identify current trends in AYA care, we examined patterns of clinical trial participation, time to treatment, and provider characteristics in a population-based sample of AYA patients with cancer.MethodsUsing the National Cancer Institute Patterns of Care Study, we used multivariate logistic regression to evaluate demographic and provider characteristics associated with clinical trial enrollment and time to treatment among 1,358 AYA patients with cancer (age 15 to 39 years) identified through the Surveillance, Epidemiology, and End Results Program.ResultsIn our study, 14% of patients age 15 to 39 years had enrolled onto a clinical trial; participation varied by type of cancer, with the highest participation in those diagnosed with acute lymphoblastic leukemia (37%) and sarcoma (32%). Multivariate analyses demonstrated that uninsured, older patients and those treated by nonpediatric oncologists were less likely to enroll onto clinical trials. Median time from pathologic confirmation to first treatment was 3 days, but this varied by race/ethnicity and cancer site. In multivariate analyses, advanced cancer stage and outpatient treatment alone were associated with longer time from pathologic confirmation to treatment.ConclusionOur study identified factors associated with low clinical trial participation in AYA patients with cancer. These findings support the continued need to improve access to clinical trials and innovative treatments for this population, which may ultimately translate into improved survival.