Estimating cure and risk of death from other causes of adolescent and young adult cancer patients in Europe.

in European journal of cancer (Oxford, England : 1990) by Laura Botta, Riccardo Capocaccia, Claudia Vener, Alice Bernasconi, Annalisa Trama, Fabio Didoné, Elena Demuru, Roberta De Angelis, Silvia Rossi, S Mohsen Mousavi, Frederik Peters, Damien Bennet, Alexandra Mayer-da-Silva, Valerie Jooste,

TLDR

  • The study finds that AYA cancer patients have a higher risk of mortality from non-cancer causes for certain cancer types, especially in younger patients.
  • The study estimates the cure fraction for AYA patients and identifies high-risk cancer types and age groups.

Abstract

Adolescents and young adults (AYAs), aged 15-39, face unique challenges as cancer survivors, including long-term health issues treatment. This study applies a novel approach to estimate the relative risk (RR) of mortality from non-cancer causes in AYA cancer patients compared to the general population and the cure fraction (CF) for AYA patients. Conventional and new mixture cure models with various parametric survival functions were applied to the most common AYA cancers. EUROCARE-6 cases diagnosed between 1998 and 2002, with follow-up to 2014, were selected. Qualitative and quantitative criteria were used to select the optimal model. CFs and RRs were estimated by cancer type, age group, and sex. RRs> 1 were found in both sexes for leukaemia, chronic myeloid leukaemia, lymphoma, central nervous system (CNS) tumours, and skin melanoma, and for testicular germ cell, breast and cervix cancers, with RR generally higher in younger patients and decreasing with age. For acute myeloid leukaemia, colorectal cancer, bone sarcoma for both sexes and soft tissue sarcoma, acute lymphoblastic leukaemia (ALL), and ovary germ cell in females, there was no indication for extra risk. Higher CFs were found in adolescents compared to older AYAs (30-39 years), especially for ALL, CNS tumours in males, and colorectal cancer in females. Further studies are needed to understand why RRs are elevated in AYA patients, to investigate comorbidities and side effects of treatment. Accurate estimation of cancer mortality and CF is vital for resource allocation, tailored follow-up care, and imporving patient quality of life.

Overview

  • The study investigates the relative risk of mortality from non-cancer causes in adolescents and young adults (AYAs) with cancer compared to the general population.
  • The study applies a novel approach using mixture cure models with various parametric survival functions to estimate the cure fraction (CF) in AYA patients with different cancer types.
  • The study aims to identify high-risk cancer types and age groups, and to estimate the CF for AYA patients to inform resource allocation and patient care.

Comparative Analysis & Findings

  • The study found elevated relative risks (RRs) of mortality for certain cancer types, including leukaemia, lymphoma, skin melanoma, and some gastrointestinal cancers, especially in younger patients.
  • The RRs were generally higher in younger patients and decreased with age.
  • The study found no indication of extra risk for certain cancer types, such as acute myeloid leukaemia, colorectal cancer, bone sarcoma, and soft tissue sarcoma.

Implications and Future Directions

  • The study's findings highlight the need for further research on the underlying causes of elevated RRs in AYA patients, including comorbidities and side effects of treatment.
  • Accurate estimation of cancer mortality and the cure fraction is vital for resource allocation, tailored follow-up care, and improving patient quality of life.
  • Future studies should investigate the specific reasons for elevated RRs in AYA patients and develop targeted interventions to address these issues.
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