The overall survival rate from cancer now is lower in older adolescents and young adults with cancer than in younger children, in part because of a lack of access to clinical trials nationally for the older age group, according to a study by pediatric oncologists at Children's Hospital of Pittsburgh of UPMC.
Nationally, cure rates in children younger than 15 with cancer have improved dramatically over the last 30 years, increasing from 60 percent to approximately 85 percent at five years from the time of diagnosis. In contrast, similar improvements in survival rates have not been seen in adolescents and young adults ages 15--22, with cure rates remaining steady at approximately 70 percent throughout the same time period.
This can be attributed to the fact that adolescents and young adults don't have the same access to cutting-edge cancer treatments provided though clinical trials, according to the study led by Peter Shaw, MD, a pediatric hematologist/oncologist at Children's Hospital and the director of the hospital's Adolescent and Young Adult (AYA) Oncology Program.
"Research has shown that patients who are enrolled in clinical trials offering the most advanced cancer treatments do better than patients who receive conventional treatment," Dr. Shaw said. "Adolescents and young adults with cancer are less likely than younger children to be enrolled in clinical trials for two important reasons: the first factor is that AYA patients are frequently treated by adult oncologists at hospitals that aren't participating in clinical trials designed for cancers occurring in the pediatric and adolescent age groups. Our study demonstrated the second reason, which is that nationally, there are many more clinical trials available for the types of malignancies that most often occur in the younger patients
Drs. Shaw and study co-author A. Kim Ritchey, MD, chief of the Division of Pediatric Hematology/Oncology at Children's and vice chair of Clinical Affairs in the Department of Pediatrics, studied 640 new oncology patients treated at Children's between July 1, 2001, and June 30, 2006. The patients ranged in age from birth to 22 years old. The study found that:
- 38 percent of patients younger than 15 were enrolled in a clinical trial.
- 27 percent of AYA patients were enrolled in a clinical trial.
- 41 percent of patients younger than 15 were not treated on a clinical trial because one was not available.
- 57 percent of AYA patients were not treated on a clinical trial because one was not available.
"These findings underscore the need for AYA patients to be treated at centers such as children's hospitals that are involved in national cooperatives offering clinical trials of new treatments for pediatric and adolescent cancers," Dr. Ritchey said. "There also is a need for more national trials to be opened for AYA patients and the types of malignancies most common to them."
The national Children's Oncology Group -- of which Children's is a member -- has an AYA subcommittee on which Dr. Shaw serves that currently is evaluating the types of cancers affecting AYA patients and ways to increase clinical trials available to these patients, according to Drs. Shaw and Ritchey.
One strategy for ensuring that AYA patients are treated by oncologists who are most up-to-date on clinical trials and cutting-edge treatment programs is for pediatric oncology divisions to establish AYA oncology programs in cooperation with adult oncology counterparts.
The study is published in the December issue of the Journal of Pediatric Hematology/Oncology.
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