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US trends in survival disparities among adolescents and young adults with non-Hodgkin lymphoma

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Abstract

Purpose

Improvement in US survival rates among adolescents and young adults (AYAs, ages 15 through 39 years inclusive) diagnosed with non-Hodgkin lymphoma (NHL) has been documented over the last two decades. We examined national trends in survival disparities for AYAs with NHL by race/ethnicity and socioeconomic status (SES, county-level poverty) to further understand NHL and to begin monitoring health outcome disparities for this disease.

Methods

Surveillance Epidemiology and End Results data were used to calculate 5-year relative survival rates of AYAs diagnosed with NHL from 1992 to 2007 and followed through 2011. Absolute and relative disparities were computed using HD*Calc. Whether a significant linear trend was present was evaluated using Joinpoint. Analyses were replicated after excluding individuals with known HIV infection.

Results

The study sample included 9,573 total and 7,121 non-HIV cases of NHL. Five-year survival rates improved for all groups over time. Significant decreases were found in absolute disparities for race/ethnicity (non-HIV), in relative disparities for SES (total) and race/ethnicity (total and non-HIV) (all p < 0.05). Survival rates of non-Hispanic Blacks and Hispanics remained below than those of non-Hispanic Whites throughout the time period.

Conclusion

Absolute and relative disparities in 5-year survival narrowed for AYAs with NHL over the time period. To continue to promote this trend, future research should investigate factors, particularly diagnostic delays and barriers to care, which continue to contribute to SES and racial/ethnic differences in survival. These factors may be particularly relevant to identify given the recent Affordable Care Act, which is designed to increase access to medical services, particularly for young adults.

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References

  1. Adolescent and Young Adult Oncology Progress Review Group (2006) Closing the gap: research and care imperatives for adolescents and young adults with cancer (NIH Publication No. 06-6067). Bethesda, MD

  2. Pulte D, Gondos A, Brenner H (2009) Trends in survival after diagnosis with hematologic malignancy in adolescence or young adulthood in the United States, 1981–2005. Cancer 115:4973–4979

    Article  PubMed  Google Scholar 

  3. Pulte D, Redaniel MT, Brenner H, Jeffreys M (2012) Changes in survival by ethnicity of patients with cancer between 1992–1996 and 2002–2006: is the discrepancy decreasing? Ann Oncol 23:2428–2434

    Article  CAS  PubMed  Google Scholar 

  4. Li Y, Wang Y, Wang Z, Yi D, Ma S (2015) Racial differences in three major NHL subtypes: descriptive epidemiology. Cancer Epidemiol 39:8–13

    Article  PubMed  Google Scholar 

  5. Kato I, Booza J, Quarshie WO, Schwartz K (2012) Persistent socioeconomic inequalities in cancer survival in the United States: 1973–2007 Surveillance, Epidemiology and End Results (SEER) data for breast cancer and non-Hodgkin’s lymphoma. J Regist Manag 39:158–166

    Google Scholar 

  6. Kent EE, Morris RA, Largent JA, Ziogas A, Sender LS, Anton-Culver H (2010) Socioeconomic impacts on survival differ by race/ethnicity among adolescents and young adults with non-Hodgkin’s lymphoma. J Cancer Epidemiol

  7. Howlader N, Ries LA, Mariotto AB, Reichman ME, Ruhl J, Cronin KA (2010) Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst 102:1584–1598

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shiels MS, Engels EA, Linet MS et al (2013) The epidemic of non-Hodgkin lymphoma in the United States: disentangling the effect of HIV, 1992–2009. Cancer Epidemiol Biomark Prev 22:1069–1078

    Article  Google Scholar 

  9. Breen N, Scott S, Percy-Laurry A, Lewis D, Glasgow R (2014) Health disparities calculator: a methodologically rigorous tool for analyzing inequalities in population health. Am J Public Health 104:1589–1591

    Article  PubMed  Google Scholar 

  10. Harper S, Lynch J, Meersman SC, Breen N, Davis WW, Reichman MC (2009) Trends in area-socioeconomic and race–ethnic disparities in breast cancer incidence, stage at diagnosis, screening, mortality, and survival among women ages 50 years and over (1987–2005). Cancer Epidemiol Biomark Prev 18:121–131

    Article  Google Scholar 

  11. An Q, Prejean J, Hall HI (2012) Racial disparity in U.S. diagnoses of acquired immune deficiency syndrome, 2000–2009. Am J Prev Med 43:461–466

    Article  PubMed  Google Scholar 

  12. Barr RD, Holowaty EJ, Birch JM (2006) Classification schemes for tumors diagnosed in adolescents and young adults. Cancer 106:1425–1430

    Article  PubMed  Google Scholar 

  13. Fritz A, Percy C, Jack A et al (2000) International classification of diseases for oncology (ICD-O), 3rd edn. World Health Organization, Geneva

    Google Scholar 

  14. NAACCR Race and Ethnicity Work Group (2011) NAACCR guideline for enhancing Hispanic/Latino identification: revised NAACCR Hispanic/Latino identification algorithm [NHIA v2.2.1]. North American Association of Central Cancer Registries, Springfield, IL

    Google Scholar 

  15. Cho H, Howlader N, Mariotto AB, Cronin KA (2011) Estimating relative survival for cancer patients from the SEER Program using expected rates based on Ederer I versus Ederer II method. Surveillance Research Program, National Cancer Institute, Bethesda, MD

  16. Health Disparities Calculator Version 1.2.4—October 29 2013. Division of Cancer Control and Population Sciences, Surveillance Research Program and Applied Research Program, National Cancer Institute

  17. Harper S, Lynch J (2005) Methods for measuring cancer disparities: using data relevant to Healthy People 2010 cancer-related objectives. NCI Cancer Surveillance Monograph Series. National Cancer Institute, Bethesda, MD

    Google Scholar 

  18. Harper S, Lynch J (2005) Selected comparisons of measures of health disparities: a review using databases relevant to Healthy People 2010 cancer-related objectives. National Cancer Institute, Bethesda, MD

    Google Scholar 

  19. Surveillance E, and End Results (SEER) Program (www.seer.cancer.gov). SEER*Stat Database: Incidence—SEER 18 Regs Research Data, Nov 2011 Sub (1973–2010) <Katrina/Rita Population Adjustment>—Linked To County Attributes—Total U.S., 1969–2010 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission

  20. Statistical Methodology and Applications Branch SRP, National Cancer Institute. Joinpoint Regression Program, Version 4.0.4—May 2013

  21. Bleyer A, Choi M, Fuller CD, Thomas CR Jr, Wang SJ (2009) Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol 36:460–467

    Article  PubMed  Google Scholar 

  22. Frederiksen BL, Dalton SO, Osler M, Steding-Jessen M, de Nully Brown P (2012) Socioeconomic position, treatment, and survival of non-Hodgkin lymphoma in Denmark—a nationwide study. Br J Cancer 106:988–995

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Woods LM, Rachet B, Coleman MP (2006) Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 17:5–19

    Article  CAS  PubMed  Google Scholar 

  24. Koroukian SM, Bakaki PM, Raghavan D (2012) Survival disparities by Medicaid status: an analysis of 8 cancers. Cancer 118:4271–4279

    Article  PubMed Central  PubMed  Google Scholar 

  25. Sandlund JT (2007) Should adolescents with NHL be treated as old children or young adults? Hematology/the Education Program of the American Society of Hematology. American Society of Hematology. Education Program, pp 297–303

  26. Keegan TH, Moy LM, Foran JM et al (2013) Rituximab use and survival after diffuse large B-cell or follicular lymphoma: a population-based study. Leuk Lymphoma 54:743–751

    Article  CAS  PubMed  Google Scholar 

  27. Flowers CR, Fedewa SA, Chen AY et al (2012) Disparities in the early adoption of chemoimmunotherapy for diffuse large B-cell lymphoma in the United States. Cancer Epidemiol Biomark Prev 21:1520–1530

    Article  CAS  Google Scholar 

  28. Bruce CJ (2007) Rituxan® anniversary: 10 years of progress. Oncol Bus Rev (November):18–19

  29. Cronin DP, Harlan LC, Clegg LX, Stevens JL, Yuan G, Davis TA (2005) Patterns of care in a population-based random sample of patients diagnosed with non-Hodgkin’s lymphoma. Hematol Oncol 23:73–81

    Article  PubMed  Google Scholar 

  30. Komrokji RS, Al Ali NH, Beg MS et al (2011) Outcome of diffuse large B-Cell lymphoma in the United States has improved over time but racial disparities remain: review of SEER data. Clin Lymphoma Myeloma Leuk 11:257–260

    Article  PubMed  Google Scholar 

  31. Frey CM, McMillen MM, Cowan CD, Horm JW, Kessler LG (1992) Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates. J Natl Cancer Inst 84:872–877

    Article  CAS  PubMed  Google Scholar 

  32. Yu M, Tatalovich Z, Gibson JT, Cronin KA (2014) Using a composite index of socioeconomic status to investigate health disparities while protecting the confidentiality of cancer registry data. Cancer Causes Control 25:81–92

    Article  PubMed  Google Scholar 

  33. Levit L, Balogh E, Nass S, Ganz PA (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. The National Academies Press, Washington, DC

  34. Zebrack B, Isaacson S (2012) Psychosocial care of adolescent and young adult patients with cancer and survivors. J Clin Oncol 30:1221–1226

    Article  PubMed  Google Scholar 

  35. Guy GP Jr, Yabroff KR, Ekwueme DU et al (2014) Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff (Millwood) 33:1024–1031

    Article  Google Scholar 

  36. Keegan TH, Tao L, Derouen MC et al (2014) Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers? J Cancer Surviv 8:282–292

    Article  PubMed Central  PubMed  Google Scholar 

  37. Aizer AA, Falit B, Mendu ML et al (2014) Cancer-specific outcomes among young adults without health insurance. J Clin Oncol 32:2025–2030

  38. Pew Hispanic Center (2011) Census 2010: 50 million Latinos: Hispanics account for more than half of the nation’s growth in past decade. Pew Research Center

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Acknowledgments

The authors would like to acknowledge Mandi Yu and Steve Scoppa for assistance in obtaining data.

Author information

Authors and Affiliations

  1. Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA

    Erin E. Kent & Ashley Wilder Smith

  2. Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Nancy Breen

  3. Data Quality, Analysis, and Interpretation Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Denise R. Lewis

  4. Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA

    Janet S. de Moor

  5. Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD, USA

    Nita L. Seibel

Authors
  1. Erin E. Kent
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  2. Nancy Breen
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  3. Denise R. Lewis
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  4. Janet S. de Moor
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  5. Ashley Wilder Smith
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  6. Nita L. Seibel
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Corresponding author

Correspondence to Erin E. Kent.

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Disclaimer Findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute.

Appendix

Appendix

See Table 3.

Table 3 Measures of racial/ethnic and area poverty level disparities in 5-year relative survival for AYAs with NHL, diagnosed 1992–2007, using data from the November 2013 release of SEERa
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Kent, E.E., Breen, N., Lewis, D.R. et al. US trends in survival disparities among adolescents and young adults with non-Hodgkin lymphoma. Cancer Causes Control 26, 1153–1162 (2015). https://doi.org/10.1007/s10552-015-0609-1

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  • DOI: https://doi.org/10.1007/s10552-015-0609-1

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