Abstract
Category:
Cancer Disparities and Inequities Research
Purpose of the study
Adolescent and young adults (AYAs, aged 13-39) with cancer face barriers to care and stagnant outcomes. National groups have called for the development of AYA-specific programs, yet how these programs influence outcomes remains largely unexplored. With a dedicated AYA Cancer Program at the University of North Carolina (UNC) since 2015, we conducted a retrospective study to describe the AYA population and compare outcomes between those receiving program support and those who did not.
Methods
Linking electronic health records and NC Cancer Registry data, we defined a cohort of AYA patients who received cancer treatment at UNC from 2014-2022. We compared sociodemographic, clinical, utilization, and supportive care measures for those who received AYA Program contact and those who did not. Chi-square and two-group t-tests were used for comparison.
Results
Of 4044 AYAs receiving care at UNC, 670 engaged with our AYA Program (Table 1). Program-contacted patients were younger at diagnosis, more likely to be Black, have metastatic disease or hematologic malignancies, and more likely to receive systemic therapy. Program patients had increased clinical trial enrollment, more palliative care and fertility counseling.
Conclusions
Our findings suggest AYAs contacted by our program represent a distinct population with higher clinical and social needs. Despite higher rates of acute care events and no-shows, they were more likely to receive guideline-recommended care - clinical trial enrollment, fertility counseling, and palliative care. Future analyses will compare outcomes using adjusted modeling, and track trends over time. Results will inform next steps for the UNC AYA Cancer Program and other centers aiming to improve care delivery for AYAs.
Notable results for AYAs with and without program contact
| . | AYA Program Contact (n=670) . | No AYA Program Contact (n=3374) . | P value . | |
|---|---|---|---|---|
| Age at diagnosis | Mean years | 27 | 31 | <0.01 |
| Sex | Female | 55% | 61% | 0.02 |
| Male | 45% | 39% | ||
| Race | White | 56% | 61% | <0.01 |
| Black | 26% | 20% | ||
| Other | 18% | 16% | ||
| Ethnicity | Hispanic | 13% | 12% | 0.29 |
| Non-Hispanic | 86% | 84% | ||
| Marital Status | Married/Partnered | 34% | 42% | <0.01 |
| Not Married | 65% | 51% | ||
| Cancer Type | Solid | 54% | 87% | <0.01 |
| Hematologic | 46% | 13% | ||
| Stage | Metastatic | 52% | 18% | <0.01 |
| Treatment | Chemotherapy | 85% | 37% | <0.01 |
| Radiotherapy | 6% | 12% | ||
| Immunotherapy | 18% | 9% | ||
| Clinical Trial Enrollment | 45% | 26% | <0.01 | |
| No-Shows | Mean | 7 | 4 | <0.01 |
| Supportive Care | Palliative care visits | 19% | 3% | <0.01 |
| Advance Care Planning | 14% | 5% | ||
| Fertility visit | 18% | 2% | ||
| Hospice enrollment | 3% | 0.7% | ||
| Complications | ED visit | 68% | 48% | <0.01 |
| Unplanned hospitalization | 63% | 29% | ||
| . | AYA Program Contact (n=670) . | No AYA Program Contact (n=3374) . | P value . | |
|---|---|---|---|---|
| Age at diagnosis | Mean years | 27 | 31 | <0.01 |
| Sex | Female | 55% | 61% | 0.02 |
| Male | 45% | 39% | ||
| Race | White | 56% | 61% | <0.01 |
| Black | 26% | 20% | ||
| Other | 18% | 16% | ||
| Ethnicity | Hispanic | 13% | 12% | 0.29 |
| Non-Hispanic | 86% | 84% | ||
| Marital Status | Married/Partnered | 34% | 42% | <0.01 |
| Not Married | 65% | 51% | ||
| Cancer Type | Solid | 54% | 87% | <0.01 |
| Hematologic | 46% | 13% | ||
| Stage | Metastatic | 52% | 18% | <0.01 |
| Treatment | Chemotherapy | 85% | 37% | <0.01 |
| Radiotherapy | 6% | 12% | ||
| Immunotherapy | 18% | 9% | ||
| Clinical Trial Enrollment | 45% | 26% | <0.01 | |
| No-Shows | Mean | 7 | 4 | <0.01 |
| Supportive Care | Palliative care visits | 19% | 3% | <0.01 |
| Advance Care Planning | 14% | 5% | ||
| Fertility visit | 18% | 2% | ||
| Hospice enrollment | 3% | 0.7% | ||
| Complications | ED visit | 68% | 48% | <0.01 |
| Unplanned hospitalization | 63% | 29% | ||
Citation Format: Jacob N. Stein, Dawn M. Ritzwoller, Alexis C. Wardell, Emily R. Haines, Bridgette Thom, Lauren Lux, Andrew B. Smitherman. UNC AYA Cancer Program: Reach and influence on cancer care delivery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6377.
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