Branko Cuglievan1, Amy Berkman2, Seyedeh Dibaj3, Jian Wang3, Clark R Andersen3, John A Livingston4, Jonathan Gill1, Archie Bleyer5, Michael Roth1. 1. Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 2. Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA. 3. Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 4. Divisions of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 5. Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Abstract
Purpose: Delays in diagnosis can affect the short-term survival outcomes of adolescent and young adult (AYA) cancer patients. We sought to determine the extent to which delayed diagnosis, health insurance type, and income status are associated with the long-term survival of AYA cancer patients. Methods: We reviewed an institutional cohort of 268 patients age 15-29 years who were diagnosed with the most common neoplasms of the AYA population between 2001 and 2003. We grouped patients by the time of onset of cancer symptomatology to verified diagnosis (lagtime to diagnosis; short or long), health insurance type at diagnosis (public or private), zip-code-based median household income (≤U.S. $50,000 or >U.S. $50,000), and demographic variables. Overall survival (OS) and late OS (LOS; the time from the 5-year anniversary of cancer diagnosis to death from any cause) were the outcomes of interest. Results: OS and LOS did not differ between those with short or long lagtimes to diagnosis for all cancer and for specific cancer types. Among patients with long lagtimes, those with private insurance had significantly better LOS than those with public insurance (p = 0.03). Compared with those who had public insurance, patients who had private insurance at diagnosis had significantly better LOS (p = 0.008). Patients with household incomes >U.S. $50,000 had better LOS than those with household incomes ≤U.S. $50,000 (p = 0.02). Patients with public insurance and household incomes ≤U.S. $50,000 had the poorest LOS. Conclusions: AYA cancer patients with either public health insurance or a low household income at diagnosis are at risk of an inferior LOS.
Purpose: Delays in diagnosis can affect the short-term survival outcomes of adolescent and young adult (AYA) cancerpatients. We sought to determine the extent to which delayed diagnosis, health insurance type, and income status are associated with the long-term survival of AYA cancerpatients. Methods: We reviewed an institutional cohort of 268 patients age 15-29 years who were diagnosed with the most common neoplasms of the AYA population between 2001 and 2003. We grouped patients by the time of onset of cancer symptomatology to verified diagnosis (lagtime to diagnosis; short or long), health insurance type at diagnosis (public or private), zip-code-based median household income (≤U.S. $50,000 or >U.S. $50,000), and demographic variables. Overall survival (OS) and late OS (LOS; the time from the 5-year anniversary of cancer diagnosis to death from any cause) were the outcomes of interest. Results: OS and LOS did not differ between those with short or long lagtimes to diagnosis for all cancer and for specific cancer types. Among patients with long lagtimes, those with private insurance had significantly better LOS than those with public insurance (p = 0.03). Compared with those who had public insurance, patients who had private insurance at diagnosis had significantly better LOS (p = 0.008). Patients with household incomes >U.S. $50,000 had better LOS than those with household incomes ≤U.S. $50,000 (p = 0.02). Patients with public insurance and household incomes ≤U.S. $50,000 had the poorest LOS. Conclusions: AYA cancerpatients with either public health insurance or a low household income at diagnosis are at risk of an inferior LOS.
Entities:
Keywords:
disparities; health insurance; household income; long-term survival
Authors: Amy M Berkman; Clark R Andersen; Vidya Puthenpura; J A Livingston; Sairah Ahmed; Branko Cuglievan; Michelle A T Hildebrandt; Michael E Roth Journal: Cancer Epidemiol Date: 2021-09-28 Impact factor: 2.984
Authors: Michael Roth; Amy Berkman; Clark R Andersen; Branko Cuglievan; J Andrew Livingston; Michelle Hildebrandt; Archie Bleyer Journal: Oncologist Date: 2022-03-04 Impact factor: 5.837
Authors: Alice S Forster; Annie Herbert; Minjoung Monica Koo; Rachel M Taylor; Faith Gibson; Jeremy S Whelan; Georgios Lyratzopoulos; Lorna A Fern Journal: Br J Cancer Date: 2022-02-22 Impact factor: 9.075