The 5-year survival rate for adolescents and young adults with cancer has significantly improved from 1975 to 2005 in the United States overall, but this was not the case for all types of cancer, according to a report published by Anderson et al in the Journal of the National Cancer Institute.
Hazel B. Nichols, PhD
“We are making improvements in survival for adolescents and young adults with cancer over time, but adolescents and young adults are a heterogeneous group, and we have to make sure that overall improvements don’t hide the fact that there are specific cancer types that haven’t had equivalent advances—and we need to do more,” said senior study author Hazel B. Nichols, PhD, member of the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center and Associate Professor in the UNC Gillings School of Global Public Health.
Study Methods
The study drew on data from the National Cancer Institute’s Surveillance, Epidemiology and End Results database. Researchers compared mortality rates in the 5 to 10 years beyond diagnosis for people aged 15 to 39. They compared mortality rates for young people in the United States who were first diagnosed with cancer between 1975 and 1984 with rates for people diagnosed in more recent time periods, including from 1985–1994, 1995–2004, and 2005–2011. Survival months were accrued from 5 years after diagnosis until death or the end of 2016.
Analysis Results
The research team found that all-cause mortality rates in the 5 to 10 years after diagnosis fell from 8.3% (95% confidence interval [CI] = 8.0%–8.6%) to 5.4% (95% CI = 5.3%–5.6%) between 1975–1984 and 2005–2011. That decline was driven by a drop in the number of deaths from the patients’ primary cancer—from 6.8% to 4.2%—said Dr. Nichols, although deaths from other causes declined as well.
The researchers identified substantial improvements in 5-year mortality rates for adolescents and young adults diagnosed with leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, central nervous system tumors, melanoma and other skin cancers, breast cancer, or kidney cancer.
KEY POINTS
- The research team found that all-cause mortality rates in the 5 to 10 years after diagnosis fell from 8.3% to 5.4% between 1975–1984 and 2005–2011.
- That decline was driven by a drop in the number of deaths from the patients’ primary cancer—from 6.8% to 4.2%—although deaths from other causes declined as well.
- While substantial improvements in 5-year mortality rates for AYA patients were noted for many tumor types, 5-year mortality rates for adolescent and young adult patients with bone tumors, soft-tissue sarcomas, bladder cancer, cervical and uterine cancers, or colorectal cancer did not improve across the study period.
However, 5-year mortality rates for adolescent and young adult patients with bone tumors, soft-tissue sarcomas, bladder cancer, cervical and uterine cancers, or colorectal cancer did not improve across the study period.
“Some of the most dramatic improvements were for leukemia and non-Hodgkin lymphoma,” said Dr. Nichols. “In those groups, we saw that if you were diagnosed with leukemia, for example, in 1975, the mortality between 5 and 10 years was almost 30%. If you were diagnosed with that same disease in 2005, the mortality rate was only 7%.”
“Cancer risk is still very low overall before 40,” she continued. “However, we haven’t seen strong representation of adolescents and young adults in clinical trials, which may be contributing to the fact that patients with certain cancer types in this age group haven’t made big advancements over this time period.”
The study authors concluded, “Over the past four decades, all-cause and cancer-specific mortality have decreased among 5-year adolescent and young adult cancer survivors overall, but several cancer types have not shared in these improvements.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com/jnci.
