Research presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting held in Chicago, Illinois, found that children, adolescents, and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who receive treatment at a specialized cancer center (SCC) through end of therapy have improved survival.
Previous to this finding, researchers have found that AYA patients who opted to receive treatment at SCCs instead of community hospitals proved to have lower early mortality 60 days post-diagnosis. Although this has been noted, the effect that location of treatment might have on long-term survival has not been thoroughly explored.
Through the use of the California Cancer Registry which was linked with a statewide hospitalization database, investigators were able to look at children and AYA ALL patients who received inpatient treatment between 1991 and 2014; children were between the ages of 0 and 18 years and AYAs were between 19 and 39 years of age. Altogether, they looked at a total of 7,724 patients in the registry.
Investigators classified patients as receiving all or part/none of their treatment at a SCC. Using inverse probability of treatment-weighted, multivariable Cox regression models, they were able to estimate associations between where the patients received their treatment, sociodemographic, as well as clinical factors with leukemia-specific survival. They presented their study results as hazard ratios (HRs) and 95% confidence intervals (CI), according to the abstract.
First of all, 21.3% of children were reported to have died over the study period; 42.6% of AYAs died as well. The median follow-up time for the study was identified as 11.6 years. They found that overall, 78% (4511) of children and 19% (356) of AYAs went to SCCs to receive their treatment over the study period.
“In multivariable models, receiving all treatment at a SCC (vs part/no care) was associated with better leukemia-specific survival (HR 0.86, CI 0.75-0.99) in children and AYAs (HR 0.83, CI 0.72-0.97),” study authors write.
Older age, Hispanic and African American race/ethnicity (compared with non-Hispanic white), public insurance (compared with private), and comorbidities, were all found to be associated with worse survival rates, in both age groups.
“Our results demonstrate that treatment at a SCC through end of therapy is associated with better leukemia-specific survival in children and AYAs,” the authors conclude. “In contrast to AYAs, the majority of children receive care at a SCC, but both age groups benefit from care at a SCC.”
These findings underscore the need for patients with ALL to be referred to and treated at SCCs, they add.
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