Youth Survival Rates Improve for HIV/AIDS-related Cancers, But Disparities Worsen

Although cancer survival rates among adolescents and young adults have improved in recent years, there are growing racial, ethnic, and socioeconomic disparities in this age group as well, according to a new study published in JNCI Cancer Spectrum.
The findings also suggest that recent progress is driven by improvements in treatments for HIV/AIDS-related cancers.
A previous report called Closing the Gap cited a lack of improvement in cancer survival from 1977 to 1997 for adolescents and young adults compared with other age groups. In the most recent study, the researchers analyzed the time period from 1988 to 2014 to examine changes in cancer survival rates to see whether gaps in survival outcomes remained.  
For adults aged 30 to 34 years old, the report showed that the 5-year survival rate increased by 20.6% in men and 4.2% in women. Among adults 30 to 39 years old, the 5-year survival rate increased by 18.9% in men and 4.2% in women.
Of all the cancers combined, adolescents and young adults demonstrated survival improvement that exceeded all other age groups, which the researchers attributed to reduced mortality in HIV/AIDS-related cancers.
Over the study period, there were no differences in survival for adolescents and young adults with bone/soft tissue sarcoma, ovarian carcinoma, ovarian germ cell tumor, stomach cancer, testicular cancer, thyroid cancer, and uterine cancer. Conversely, survival rates showed the greatest improvement for Kaposi sarcoma, chronic myeloid leukemia, and non-Hodgkin lymphoma. The study authors found that these survival improvements were more evident in those from higher socioeconomic groups. Both Kaposi sarcoma and non-Hodgkin lymphoma disproportionately affect individuals with HIV/AIDS, according to the study.
The researchers likened the previous negative survival improvement gap in this age group to the rise and height of HIV/AIDS-related cancers in men. Subsequently, the dramatic improvements observed among adolescents and young adults in this study, especially among men, may correspond to the advent of effective treatment for HIV/AIDS, the authors noted.
Black patients had the highest risk of death compared with white adolescents and young adults, followed by Asian-Pacific Islanders and Latinos, according to the study. Compared with white patients, survival disparities for every racial/ethnic minority group continued to worsen. Worsening survival trends were observed for black patients with bone/soft tissue sarcoma, women 20 to 24 years old with cervical cancer, and poor adolescents and young adults with cervical cancer.
The strongest predictor of death was cancer stage, with advanced stage cancer associated with the worst outcomes. 
According to the researchers, the findings point to growing survival disparities in this age group and the need for increased attention to inequities in cancer care.
“This highlights that continued research is required in this vulnerable age group,” lead author Diana Moke, MD, said in a press release. “This research is necessary to improve survival in certain cancer types that have not shown any recent progress, find novel therapies for advanced stage disease in all cancer types, and ensure that survival improvements reach all young patients, regardless of race/ethnicity or socioeconomic status.”
Moke DJ, Tsai K, Hamilton AS, et al. Emerging cancer survival trends, disparities, and priorities in adolescents and young adults: A California cancer registry-based study. JNCI Cancer Spectrum. 2019.

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