Treatment Complications and Survival Among Children and Young Adults With Acute Lymphoblastic Leukemia
| Autor: | Marcio H. Malogolowkin, Qian Li, Lori Muffly, Theodore Wun, Elysia Alvarez, Brad H. Pollock, Ann Brunson, Jeffrey S Hoch, Theresa H.M. Keegan |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Pediatrics medicine.medical_specialty Databases Factual Adolescent Pediatric Cancer Childhood Leukemia Lymphoblastic Leukemia MEDLINE ORIGINAL CONTRIBUTIONS Tertiary Care Centers Databases Young Adult 03 medical and health sciences Rare Diseases 0302 clinical medicine Treatment complications Clinical Research medicine Humans Young adult Child Preschool Factual INDUCTION TREATMENT Proportional Hazards Models Cancer 030304 developmental biology Pediatric 0303 health sciences Oncology (nursing) business.industry Health Policy Infant Newborn Infant Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Newborn medicine.disease Hospitalization Survival Rate Oncology Child Preschool 6.1 Pharmaceuticals 030220 oncology & carcinogenesis Acute Disease business |
| Zdroj: | JCO oncology practice, vol 16, iss 10 JCO Oncol Pract |
| ISSN: | 2688-1535 2688-1527 |
| DOI: | 10.1200/jop.19.00572 |
| Popis: | PURPOSE: We previously demonstrated lower early mortality for young adults (YAs) with acute lymphoblastic leukemia (ALL) who received induction treatment at specialized cancer centers (SCCs) versus community hospitals. The aim of this study is to determine the impact of inpatient location of treatment throughout therapy on long-term survival, complications, and cost—associations that have not yet been evaluated at the population level. METHODS: Using the California Cancer Registry linked to a hospitalization database, we identified patients, 0-39 years of age, diagnosed with first primary ALL who received inpatient treatment between 1991 and 2014. Patients were classified as receiving all or part or none of their inpatient treatment at an SCC within 3 years of diagnosis. Inverse probability–weighted, multivariable Cox regression models estimated the associations between location of treatment and sociodemographic and clinical factors with survival. We compared 3-year inpatient costs overall and per day by age group and location of care. RESULTS: Eighty-four percent (0-18 years; n = 4,549) of children and 36% of YAs (19-39 years; n = 683) received all treatment at SCCs. Receiving all treatment at an SCC was associated with superior leukemia-specific (hazard ratio [HR], 0.76; 95% CI, 0.67 to 0.88) and overall survival (HR, 0.87; 95% CI, 0.77 to 0.97) in children and in YAs (HR, 0.71; 95% CI, 0.61 to 0.83; HR, 0.70; 95% CI, 0.62 to 0.80) even after controlling for complications. The cost of inpatient care during the full course of therapy was higher in patients receiving all of their care at SCCs. CONCLUSION: Our results demonstrate that inpatient treatment at an SCC throughout therapy is associated with superior survival; therefore, strong consideration should be given to referring these patients to SCCs. |
| Databáze: | OpenAIRE |
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