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Survival Among Adolescents and Young Adults Using JPSurv and SEER9, 1975-2015

Survival Among Adolescents and Young Adults Using JPSurv and SEER9, 1975-2015. Denise Riedel Lewis, Ph.D., M.P.H., Epidemiologist, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD. Conflicts: Nothing to Declare.

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Survival Among Adolescents and Young Adults Using JPSurv and SEER9, 1975-2015

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  1. Survival Among Adolescents and Young Adults Using JPSurv and SEER9, 1975-2015 Denise Riedel Lewis, Ph.D., M.P.H., Epidemiologist, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

  2. Conflicts: Nothing to Declare

  3. Introduction to AYA and Cancer Survival

  4. Background • 2005, NCI Progress Review Group convened to examine research gaps in adolescent and young adult (AYA) cancer. • 2006, NCI monograph: Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age: Incidence and Survival 1975 to 2000. Set the stage for thinking about cancer in this age group. • Age group changed to 15 to 39 years of age. • Current study purpose was to consider and evaluate survival outcomes of cancer sites with the highest mortality among AYA population using SEER data to see if survival has improved.

  5. Methods

  6. Statistical Analysis: Two Phases • 1) Mortality rate evaluation: • NCHS US mortality file used to evaluate top 5 cancer sites with highest mortality rates among AYAs aged 15-19 and 20-44. Allow for deaths that may have occurred among those diagnosed at age 39 later on. • 2) Survival analysis: • SEER9 incidence data used to analyze survival from 1975 to 2014 for those cancers with higher mortality. • AYA age in two groups by gender: 15-19 and 20-39, differences in sites of importance. • Cancer site or type coding based on International Classification of Childhood Cancer (ICCC), based on ICD-O-3/WHO 2008. Emphasis on tumor morphology rather than primary site for adults. https://seer.cancer.gov/iccc/ • JPSurv program for cumulative relative survival and survival trend with respect to year of diagnosis. Renaming measure as ACCS: average change in cumulative survival. • 5-year cumulative relative survival trend as the outcome. Reported as the absolute percent change per year at the p<0.05 significance level.

  7. Cancer Surveillance and SEER Areas, Data Source • SEER has been collecting cancer incidence data since 1973. Authorized by the National Cancer Act of 1971. • SEER9 analysis file currently includes nearly 5 million tumors and covers 9.4% of the US population. • SEER9 Registries • San Francisco-Oakland • Connecticut • Detroit • Hawai’i • Iowa • New Mexico • Seattle/Puget Sound • Utah • Atlanta

  8. Updated Cancer Surveillance and SEER Areas • Newly added registries include Massachusetts, New York, Wisconsin, and Idaho. • Current data file includes up to 21 registries and covers 34.6% of the US population. More than 10 million tumors with more than 600,000 tumors for 2016.

  9. Analysis Presentation • Mortality rates for 15-19 and 20-44 from NCHS mortality rate files for 1975 to 2015 by gender. Top 5 cancers for each of these 4 subgroups. • 5 year cumulative relative survival in percents for the top 5 cancers in above demographic subgroups reflecting survival trends with respect to year of diagnosis. • See if there are improvements in the survival trends for AYAs. • Cumulative relative survival is the ratio of the proportion of observed survivors for all causes of death in a cohort of cancer patients to the proportion of expected survivors in a comparable cohort of cancer free individuals.

  10. Results

  11. Mortality: Top 5 Cancer Causes of Death,15-19, Year of Death 1975-2015, US Mortality File

  12. Top Five Cancer Causes of Death, US 15 to 19 Year OldsNCHS US Mortality

  13. Mortality: Top 5 Cancer Causes of Death, 20-44, Year of Death 1975-2015, US Mortality File

  14. Top Five Cancer Causes of Death, US 20 to 44 Year OldsNCHS US Mortality

  15. Predicted Five Year Cumulative Relative Survival, Top 5 Mortality Cancer Sites, Males 15-19, SEER9, Year of Diagnosis, 1975-2014

  16. Predicted Five Year Cumulative Relative Survival, Top 5 Mortality Cancer Sites, Females 15-19, SEER9, Year of Diagnosis, 1975-2014

  17. Predicted Five Year Cumulative Relative Survival, Top 5 Mortality Cancer Sites, Males 20-39, SEER9, Year of Diagnosis, 1975-2014

  18. Predicted Five Year Cumulative Relative Survival, Top 5 Mortality Cancer Sites, Females 20-39, SEER9, Year of Diagnosis, 1975-2014

  19. Predicted Five Year Cumulative Relative Survival for Brain/CNS, Colon and Rectum, and Lung and Bronchus, SEER9, by Gender, Ages 20 to 39

  20. Conclusions

  21. Conclusions • For 15 to 19 year old AYAs for males and females, each of their top 5 cancer mortality sites have shown survival improvement over the period of diagnosis examined. Five-year cumulative relative survival above 60% more recently for most cancer types. • Survival curve for female breast cancer supports earlier findings of improved outcome with adjuvant therapy including hormonal therapy in 1985 or so, and treatments were developed after 1987 to target HER2. • Steady prognosis has been seen for YA females since 2001 in lung cancer related to improved surgical techniques and supportive care. • Despite improved survival trends for females 20 to 39 for 4 of their top 6 sites for cancer mortality, there was a lack of significant improvement in survival for ovary, and cervix uteri for the entire period as the trends were flat and non-significant. • Five year cumulative relative survival among females for brain/CNS and CRC shows signs of exceeding that for males with cross over in survival in 2003-2004.

  22. Conclusions • NHL survival analysis limited by unknown HIV infection status, perhaps masking improved survival for those without HIV. • Emerging patterns in AYA survival of cancer types associated with older age groups are of concern and should be followed: • different lung and bronchus survival trends in males vs. females • colon and rectum cancer survival shows signs of slowing. • Inform the cancer control community of the more impactful cancer types faced by AYAs to help advocate for timely diagnosis, appropriate primary care, prevention, and future research.

  23. Acknowledgements, NCI Co-Investigators Nita Seibel, M.D. Elizabeth Siembida, Ph.D. Ashley Wilder Smith, Ph.D. Angela Mariotto, Ph.D.

  24. Contact Information: Denise Riedel Lewis, Ph.D., M.P.H. Epidemiologist NCI, DCCPS, Surveillance Research Program https://surveillance.cancer.gov https://seer.cancer.gov 240-276-6757 www.researchgate.net/profile/Denise_Lewis3 lewisde@mail.nih.gov

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