Work

Response to Siegel et al.

Year: 2019

Type: article

Abstract: We thank Siegel et al. for their interest in our report. The dramatic image of the “Adolescent and Young Adult (AYA) Gap,” a substantial deficit in survival improvement among AYAs (age 15-39 years) with cancer as compared with younger and older population as presented in the landmark 2006 National Institutes of Health (NIH) Progress Review Group (PRG) Report on AYA Oncology (1), is undeniably impactful and long-lasting. Based on the Surveillance, Epidemiology, and End Results (SEER) Program data from 1975 to 1997, it was largely responsible for triggering the AYA advocacy movement and has since been cited regularly in AYA cancer literature. As noted in our report, the impact of the HIV/AIDS epidemic on survival has indeed been published for certain cancers, but its contribution to the overall AYA cancer survival deficit had not been comprehensively documented. Although limited information connecting the HIV/AIDS epidemic and the reduction in overall cancer survival among those ages 15–29 years was reported separately in another NIH monograph, also published in 2006 (2), that message was largely unnoticed by professional and public audiences, as evidenced by continued citation of the 2006 PRG Report, as recently as August 2018 (3). Our objective was to reevaluate the AYA survival trend, accounting for the impact of HIV/AIDS on the survival of some cancers, to update the overall AYA cancer survival overview since the 2006 PRG Report. We stand by our conclusion, as supported by the data analysis, that AYA cancer survival is generally better than other age groups. Siegel et al. disagree and suggest that thyroid cancer should be excluded from survival trends assessments of AYAs because of concerns for overdiagnosis and higher incidence among AYAs. We disagree with such selective exclusion and its effect of artificially lowering the overall AYA cancer survival rate. This selective exclusion of thyroid cancer and inclusion of HIV/AIDS-related cancers for females likely explains their results presented in Figure 1 of their correspondence, suggesting comparable survival rates between AYAs and younger patients after 1993, in contrast to our sex-specific findings showing better AYA survival. We feel their use of findings in Trama et al. 2018 (3) as evidence for lower AYA survival than children’s is less appropriate, because only “common cancers” were included in that analysis rather than “all cancers” as in ours. Although their emphasis on AYAs having “less improvement than in younger and older patients” agrees with our analysis, we would like to reiterate one of our important findings—ie, the relative “survival improvement” alone is not a sufficient metric for evaluating progress—needs to be combined with absolute survival rates to provide a complete picture. Despite having “lower survival improvement,” AYAs have better overall cancer survival before and after the HIV/AIDs epidemic era. We wholeheartedly agree with Siegel et al. that there is much to be accomplished in AYA oncology. Having an up-to-date and accurate understanding of AYA survival will enable prioritizing resources for improving survival from highest-risk cancers, reducing treatment toxicity and long-term side effects, providing age appropriate care, removing barriers to treatment, and advancing knowledge and intervention on psychosocial wellness and other life course issues facing AYA cancer survivors. Affiliations of authors: Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (LL, KYT, AH, ASH, JZ, MC, DD); Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA (DJM, DRF); USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (DRF, MC, DD); University of Colorado, Denver, CO (MC).

Source: JNCI Journal of the National Cancer Institute

DOI: 10.1093/jnci/djz025