1. Cancer in Adolescents and Young Adults An International Perspective Ronald D. Barr MB ChB, MD Professor of Pediatrics, Pathology and Medicine McMaster University Hamilton, Ontario Canada 2010 Texas AYA Oncology Conference
9. Non-Hodgkin Lymphoma 7% Hodgkin Lymphoma 12% Melanoma 11% Female Genital 10% Testis Cancer 11% Thyroid Carcinoma 10% CNS Neoplasms 6% Soft-Tissue Sarcomas 8% Bone Tumors 3% Non-Gonadal Germ Cell Tumors 2% Other 2% Other Carcinomas 6% Breast Cancer 5% Leukemia 6% AYA Cancers are Unique in Type and Biology Age 15-29 Years
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12. Improvement in 5-Year Relative Survival, Canada Ontario, Canada - Courtesy of Loraine Marrett Age at Diagnosis (Years) 0 15 30 50 65 80
13. Are disparities in 5 year survival rates and AAPC reflections of differences in health care systems? Personal communication March 11, 2010 Barack Obama
14. Age at Diagnosis (Years) Average Annual % Change 0 1 2 0 10 20 25 30 35 40 50 60 70 80 5 15 90 Australia UnitedStates Improvement in Relative Survival by Age at Diagnosis of Invasive Cancer, 1982-1997 Prepared by A. Bleyer from data provided by the Australia Institute of Health and Welfare and from U.S. SEER9
15. 50% 60% 70% 80% 90% 0 5 10 15 20 25 30 35 40 50 60 70 Australia Age at Diagnosis (Years) Relative Survival, All Invasive Cancer Australia vs. United States, 1992-1997 5-Year Survival 80 5% 8% 12% 8% 5% U.S. Australia data provided by: Chris Stevenson, AIHW
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21. OBSERVED CASES IN THE AIEOP CENTERS versus EXPECTED NUMBER OF CASES IN ITALY (from population-based childhood cancer registries in Italy) A.Ferrari, A.Pession, M.Aricò, R.Rondelli, and G.Pastore patients 0-14 years patients 15-19 years all childhood cancers 82% 10% LLA 98% 23% HD 89% 9% NHL 80% 14%
22. patients 0-14 years patients 15-19 years CNS tumors 66% 14% NBL 91% 43% renal tumors 85% 15% bone sarcomas 93% OS 28% EW 43% OBSERVED CASES IN THE AIEOP CENTERS versus EXPECTED NUMBER OF CASES IN ITALY soft tissue sarcomas RMS 97% NRSTS 74% RMS 33% NRSTS 39% ependymoma 35% PNET 41% germ-cell 53% carcinomas 1%
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24. Age (Years) Number of Patients with Cancer in the U.S.A. On Cooperative Group Trial 60% 2% 33% 29% 11% 6% 60% 40% 50% 10% 0-4 5-9 10-14 15-19 Not at NCI-Sponsored Cooperative Group Institution At Cooperative Group Institution 20-30 The Adolescent-Young Adult Gap in Cancer Clinical Trials 79% 92% 21%
25. Clinical Trial Accrual in the U.S. 0 2001-2003 Patient Age (Years) No. Accruals 2004-2006 decreasing 0 5 10 15 20 25 30 35 40 45 50 55 2,000 4,000 6,000 8,000 10,000 2004-2006 increasing Courtesy of A. Bleyer. MD 10 15 20 25 30
26. U.S. Cancer Patients Entered onto National Treatment Trials 2003-5 vs. 2000-2 No. Accruals 0-14 15-29 30-44 45-59 60-74 Age (Years) 0 5,000 10,000 15,000 20,000 25,000 30,000 2000-2 2003-5 Change from 2000-2 to 2003-5 42% -3% -4% -40% 0% 40% -28% -50% 9,767 3,687 7,506 28,369 28,015 7,017 5,219 3,749 27,487 26,962
27. 5 10 15 20 25 30 35 40 Ave. Ann. Change, 5-Yr Survival 0% 0.5% 1.0% 1.5% 0 Age (Years) Survival improvement is correlated with clinical trial participation 0% 1% 2% 1% 10% p = .0003 Accrual Proportion (log)) Ave. Ann. Change, 5y Surv. Accrual Proportion 0% 10% 20% 30%
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Editor's Notes
Courtesy of Loraine Marrett
[email_address]
The deficit in the U.S. began at 16 and ended at age 55, the years that national health insurance is not available in the U.S. The deficit ranged from 5% to 12%, with maximum between ages 30 and 35.
U.S. Cancer Patients Entered onto National Treatment Trials, 2003-5 vs. 2000-2
