Long-term survival among 5-year survivors of adolescent and young adult cancer

Abstract

Background: Although there are a growing number of survivors of adolescent and young adult (AYA) cancer, to the authors' knowledge the long-term overall survival (OS) patterns for AYA cancer survivors are underreported. The objective of the current study was to assess the long-term survival of AYA cancer survivors and identify factors associated with diminished long-term survival.

Methods: The authors used The University of Texas MD Anderson Cancer Center's tumor registry to identify 5-year survivors of cancer diagnosed as AYAs (ages 15-39 years) between the years 1970 and 2005, and who were alive 5 years after diagnosis. Kaplan-Meier curves were used to estimate OS rates over time, and Cox proportional hazards models were fitted to evaluate the association of covariates with OS.

Results: The authors identified 16,728 individuals who were 5-year survivors of cancer and were diagnosed as AYAs with a median follow-up of 20.0 years. The 10-year, 20-year, and 25-year OS rates were 86% (95% confidence interval [95% CI], 85%-86%), 74% (95% CI, 73%-75%), and 68% (95% CI, 67%-68%), respectively, all of which were lower than the age-adjusted estimated survival rates of the general population. Long-term OS improved for AYAs diagnosed between 2000 and 2005 compared with those diagnosed in the prior decades (P < .001). Older age at the time of diagnosis, receipt of radiation, and diagnoses including central nervous system tumors and breast cancer each were associated with diminished long-term survival.

Conclusions: AYA cancer survivors have inferior long-term survival compared with the general population. Studies investigating the prevalence and types of late treatment effects and causes of death among AYA survivors are needed to more accurately identify AYAs who are at highest risk of early or late mortality.

Keywords: adolescent and young adult; cancer; disparities; long-term outcomes; survival; survivorship.

Figure 1:. Overall Survival of AYA Cancer Survivors.

(A) The overall survival estimate of all 5-year AYA cancer survivors was lower than that of the U.S. general population (P<.001). (B) The overall survival estimate of 5-year AYA cancer survivors diagnosed in the 2000s was higher than those of survivors diagnosed in the 1970s, 1980s, or 1990s.

Figure 2:. Overall Survival of AYA Cancer Survivors by Race, Gender, Age at Diagnosis, and Different Ages by Decade of Diagnosis.

(A) Overall survival estimates of 5-year AYA cancer survivors by gender. The overall survival estimate for female survivors was higher than that of male survivors (P=.01). (B) Overall survival estimates of 5-year AYA cancer survivors by race. The overall survival estimate for white survivors was higher than that of black survivors (P=.01). (C) Overall survival estimates of 5-year AYA cancer survivors by age at diagnosis. AYA cancer survivors diagnosed between ages 15 and 19 and 20 and 29 had higher overall survival compares with AYAs diagnosed between ages 30 and 39 (P<.001) (D) AYA cancer survivors diagnosed between ages 15 and 19 years during the years 2000–05 had improved overall survival compared with AYA survivors diagnosed in the prior 3 decades (P<.001). (E) AYA cancer survivors diagnosed between ages 20 and 29 years during the years 2000–05 had improved overall survival compared with AYA survivors diagnosed in the prior 3 decades (P<.001). (F) AYA cancer survivors diagnosed between ages 30 and 39 years during the years 2000–05 had improved overall survival compared with AYA survivors diagnosed in the prior 3 decades (P<.001).

Figure 3:. Overall Survival of the Survivors of the Five Most Prevalent AYA Cancer Types.

(A) Overall survival estimates of the 5-year survivors of the 5 most prevalent AYA cancer types. (B) Five-year AYA breast cancer survivors diagnosed between the years 2000–05 had improved overall survival compared with survivors diagnosed in the prior 3 decades (P<.001). (C) Five-year AYA melanoma survivors diagnosed between the years 2000–05 had improved overall survival compared with survivors diagnosed in the prior 3 decades (P<.001). (D) Five-year AYA CNS survivors diagnosed between the years 2000–05 had improved overall survival compared with survivors diagnosed in the prior 3 decades (P<.001). (E) Overall survival estimates of 5-year AYA thyroid cancer survivors by decade of diagnosis. (F) Five-year AYA lymphoma survivors diagnosed between the years 2000–05 had improved overall survival compared with survivors diagnosed in the prior 3 decades (P<.001).

Figure 4:. Overall Survival of AYA Cancer Survivors by Radiotherapy Status.

Group 1 did not receive any radiotherapy and included survivors who received chemotherapy; surgery; chemotherapy plus surgery; or other treatment. Group 2 received radiotherapy and included survivors who received radiotherapy; radiotherapy and chemotherapy; radiotherapy and surgery; or radiotherapy, chemotherapy, and surgery.