Trends in patterns of treatment of childhood cancer in Los Angeles County

Site of Oncologic Specialty Care for Older Adolescents in Utah

Purpose

Adolescents with cancer may access oncologic care from pediatric or adult medical centers, given overlapping age eligibility. However, some recent data suggest a benefit to adolescents with certain cancers when treated at pediatric centers or on pediatric protocols. We used a population-based registry to determine the site of care of children, adolescents, and young adults (age 0 to 24 years) with newly diagnosed cancer.

Patients and Methods

From the Utah Cancer Registry 1994 to 2000, new malignant cases in patients aged 0 to 24 years were chosen; data including diagnosis, home ZIP code and sites of oncologic care were abstracted. Distance between home ZIP code and Primary Children's Medical Center (PCMC; Salt Lake City, Utah), the state's sole site of pediatric oncology care, was determined.

Results

Sixty-six percent of Utah 15- to 19-year-olds with cancer were never seen by a PCMC oncologist. Even among this narrow age range, utilization of the pediatric center dropped with each additional year of age. Not unexpectedly, few of those with epithelial malignancies in this age group were seen at PCMC. But surprisingly, 47% of the older adolescents with leukemia, 66% with brain tumors, and 71% with lymphoma never saw a pediatric oncologist. After consideration of age and diagnosis, distance the patient lived from PCMC had a negligible effect on the likelihood of an adolescent being seen there.

Conclusion

The referral of adolescents with cancer to a pediatric oncology center diminishes greatly with age, and is moderately influenced by diagnosis and minimally by distance from center. Further study should investigate reasons for referral patterns, and impact on outcomes.

Gynecologic Malignancies in Women Aged Less Than 25 Years

OBJECTIVE

To describe the epidemiologic characteristics of gynecologic malignancies in patients 25 years of age or younger.

METHODS

The Automated Central Tumor Registry (ACTUR), the cancer registry for the Department of Defense, was used to identify children, adolescents, and young adults diagnosed with gynecologic malignancies. Specifically, primary ovarian, uterine, cervical, vaginal, and vulvar malignancies diagnosed between 1990 and 2002 were included in the analysis. Data from the Department of Defense tumor registry were then compared with results obtained from the national Surveillance, Epidemiology, and End Report (SEER) program database.

RESULTS

Two hundred fifty-one cases were identified in the Department of Defense tumor registry. The most common primary site was ovary, with 116 cases (46%), followed by cervix, with 108 cases (43%). The most common histological types were germ cell (35%) for ovary, squamous cell (52%) for cervix, choriocarcinoma (18%) for uterus, and squamous cell (30%) for vulva/vagina. The 21- to 25-year-old age group had the greatest number of cases for the entire cohort (23%). Most patients had only local disease at time of diagnosis, and the 5-year survival percentage was 86% (95% confidence interval 80-91) for all patients with ovarian and cervical carcinoma. Data from the SEER program demonstrated a similar distribution and incidence pattern.

CONCLUSION

The ovary and cervix are the most common primary sites of gynecologic malignancies in patients 25 years of age or younger. Health maintenance programs for patients in this age group should continue to include pelvic exams and Pap test screening.

Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation

BACKGROUND

Evidence from clinical trials has documented improvements in event-free survival from childhood rhabdomyosarcoma (RMS) since the 1970s; however, the survival experience of children enrolled on cancer clinical trials may not reflect the full range of patients treated in community settings. The current study evaluated 5-year survival and 10-year conditional survival for RMS from U.S. population-based cancer registry data.

METHODS

Public-use data from the Surveillance, Epidemiology, and End Results (SEER) program were used in life table and Cox regression analyses to evaluate RMS survival by patient age at diagnosis, gender, tumor histology, tumor site and stage, and major treatment eras among 848 children who were age < 20 years at the time of diagnosis, were a resident of 1 of 9 geographic reporting regions, and were diagnosed between 1973 and 2000.

RESULTS

The 5-year survival probabilities were found to be highest for younger-age children (ages 1-4 years: 77%), patients with localized disease (83%), those whose tumors had an embryonal histology (67%), and patients with orbital (86%) and genitourinary (80%) tumor sites. Poor prognosis was associated with diagnosis during infancy (47%) and adolescence (48%); metastatic disease at the time of presentation (31%); alveolar histology (49%); and tumors of the extremities (50%), retroperitoneum (52%), and trunk (52%). Conditional 10-year survival probabilities among those who survived > or = 5 years were 85% or higher. The probability of survival by stage at the time of diagnosis increased with each successive treatment era, suggesting a stage shift phenomenon over time.

CONCLUSIONS

Large variations in 5-year survival were evident depending on patient age and tumor characteristics. However, children who survived the first 5 years after diagnosis were found to have an excellent long-term prognosis. The patterns in RMS survival noted from the current population-based evaluation did not appear to differ substantially from those previously reported by major clinical trials.

Childhood cancer patients' access to cooperative group cancer programs: a population-based study

BACKGROUND

The Children's Oncology Group (COG), a merger of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG), conducts clinical trials for the treatment of childhood cancer. To assess the feasibility of developing a nationwide childhood cancer registry, the authors attempted to determine whether COG could serve as a resource for identifying all children with cancer.

METHODS

A consolidated file of children age < 20 years who were diagnosed with cancer between 1992-1997 and registered with either CCG or POG was linked with records from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. Age-specific registration rates and age-adjusted registration rates (AARR) were calculated overall and by year of diagnosis, gender, race/ethnicity, stage of disease at diagnosis, and type of cancer.

RESULTS

Of 10,108 children age < 20 years with cancer who were identified by the 11 SEER registries between 1992-1997, 5796 were registered with CCG or POG. The AARR was 71% for children age < 15 years, 24% for adolescents ages 15-19 years, and 57% for children age < 20 years. Registration rates were stable over the years studied, varied by geographic region, and were found to be higher among children with more advanced disease. Registration rates were highest for children with leukemia, hepatic tumors, and renal tumors, and were lowest for carcinoma and retinoblastoma.

CONCLUSIONS

The results of the current study demonstrate that not all children with cancer are registered by the cooperative groups; however, a national registry program can be achieved by supplementing cases identified through COG with data collected by statewide population-based cancer registries. Such a partnership would be mutually beneficial, allowing COG to achieve 100% registration of children with cancer and, for the statewide cancer registries, improving the timeliness of case-finding and follow-up information for cancer outcomes.

Socioeconomic and demographic factors that predict where children receive cancer care in Florida

Socioeconomic and demographic factors associated with type of facility (cancer center vs non-cancer center) at which a child with cancer is seen were identified to suggest interventions to increase access to state-of-the-art care. The 2268 children with cancer in Florida (1981-1986) were classified as ever having been seen or not having been seen at a cancer center. Patients referred from one type of facility to another were compared to those not referred. Nineteen percent of children with cancer were never seen at a cancer center. These children were likely to be older (15-19 years of age), have Hodgkin's disease or a brain tumor, reside in a county without a cancer center, or have higher median income. Interventions extending state-of-the-art cancer care beyond cancer centers should target (1) physicians treating adolescent-aged children and (2) patients for whom private insurance may serve as a barrier to referral and protocol therapy.

Patterns of enrollment on cooperative group studies. An analysis of trends from the Los Angeles County Cancer Surveillance Program

To assess the proportion of children diagnosed with cancer who are enrolled on studies conducted by the two national pediatric cooperative groups, population-based cancer incidence data for Los Angeles county children younger than age 20 for the years 1980 through 1987 were linked with patient records of children registered with the Childrens Cancer Group (CCG) or the Pediatric Oncology Group (POG). For patients not enrolled on a protocol, demographic and disease characteristics were compared with summary eligibility requirements for CCG protocols that were open for enrollment during 1980-1987. The proportion of patients enrolled on studies conducted by the cooperative groups varied with tumor type and age at diagnosis. When patients younger than the age of 10 were diagnosed at an institution affiliated with one of the groups, the majority of those evaluated by our review as eligible for a study were enrolled on a protocol. The proportion of young patients entered on study among those whose diagnosis was not made at a cooperative group institution was generally smaller. Seventy-three percent of all potentially eligible patients with acute leukemia diagnosed between 1980-1987 were entered on a pediatric group protocol. Approximately 50% of all potentially eligible patients with brain tumors were entered on protocol. In contrast to this, less than 50% of patients older than the age of 14 and likely to be eligible for a study were entered on a pediatric group protocol, regardless of the tumor type. Indeed, bone tumors constituted the category of patients most likely to be enrolled, with 39% of all potentially eligible patients entered on a study in the period examined. If the patient's diagnosis was made at a cooperative group institution, the individual was more likely to be entered on a protocol than if the diagnosis was made at a center outside the cooperative group network. It was not possible to determine the precise reason for this trend from the data available. Some explanations include policies at cooperative group institutions regarding admission of patients older than age 14 and the availability of protocols from cooperative groups primarily focused on the treatment of cancers of adults.