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Ferrari A, Bernasconi A, Sironi G, Bergamaschi L, Botta L, Chiaravalli S, Casanova M, Bisogno G, Milano GM, Mascarin M, Tornesello A, Quarello P, Massimino M, Gatta G, Trama A. Where Are Adolescents with Soft Tissue Sarcomas Treated? An Italian Nationwide Study on Referrals Based on Hospital Discharge Records. J Adolesc Young Adult Oncol 2019; 9:190-195. [PMID: 31660779 DOI: 10.1089/jayao.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents (15-19 years) with soft tissue sarcomas (STS) have worse survival than children. One reason is the former's limited access to expert centers. We investigated where adolescents with STS are treated in Italy, analyzing hospital discharge records (HDRs) countrywide. Methods: We applied to the Health Ministry to obtain the HDRs of all adolescents hospitalized in 2002-2015. We excluded prevalent cases hospitalized with STS in 2002-2006 to obtain a cohort of incident cases 2007-2014. We defined main treatments observing 12 months from diagnosis. Thus, the cohorts end in 2014 rather than 2015. We computed "hospital volume" as the number of adolescents treated by a hospital in 8 years. Patient migration across geographical areas was investigated comparing patients' place of residence and of hospitalization. Results: We identified 381 adolescents with STS, 63% of them were treated at AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica [Italian Association of Pediatric Hematology and Oncology]) centers. These patients were treated at 44 different AIEOP centers, with 1 center treating 62 adolescents (26% of all those treated by AIEOP centers). The remaining 142 adolescents with STS were treated at 66 non-AIEOP centers, one of which managed 17 adolescents. Centers in the north of Italy were more likely to attract patients from other regions. Conclusion: Although HDRs have some limitations, they are the only tool for investigating access to care in countries without national cancer registries. Our findings support the use of HDRs for such purposes, confirm the efficacy of the Italian pediatric oncology network, and make the case for closer collaboration between pediatric and adult oncologists.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Trama A, Bernasconi A, McCabe MG, Guevara M, Gatta G, Botta L, Ries L, Bleyer A. Is the cancer survival improvement in European and American adolescent and young adults still lagging behind that in children? Pediatr Blood Cancer 2019; 66:e27407. [PMID: 30124231 DOI: 10.1002/pbc.27407] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 01/23/2023]
Abstract
Improvements during 1978 to 2006 in the 5-year survival rate of adolescents and young adults (AYAs, age 15-39) and children with cancers common to both age groups were evaluated for 1978 to 2006 in Europe and the USA. AYAs had absolute survival increases of 25% and 15% in Europe and the USA, respectively, but in both cases, AYA 5-year survival was, as of 2006, 4% lower than those in children. Acute lymphoblastic leukemia (ALL) explained most of the survival difference between AYAs and children on both the continents. In the USA, 20- to 39-year-olds with ALL have had less survival improvement than those in Europe.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Martin G McCabe
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Marcela Guevara
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Archie Bleyer
- Oregon Health and Science University, Portland, Oregon.,University of Texas Medical School at Houston, Houston, Texas
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