Adolescent and young adults (AYA, ages 15-39 years) diagnosed with cancer comprise a growing, yet understudied, population. Few studies have examined disparities in cancer survival in underserved and diverse populations of AYAs.
Using population-based data from the Texas Cancer Registry, we estimated five-year relative survival of common AYA cancers and examined disparities in survival by race/ethnicity, neighborhood poverty, urban/rural residence, and insurance type. We also used multivariable Cox proportional hazards regression models to examine associations of race/ethnicity, neighborhood poverty, urban/rural residence, and insurance type with all-cause mortality.
We identified 55,316 women and 32,740 men diagnosed with invasive cancer at age 15-39 years between January 1, 1995, and December 31, 2016. There were disparities in relative survival by race/ethnicity, poverty, and insurance for many cancer types. Racial/ethnic disparities in survival for men with non-Hodgkin Lymphoma (74.5% [95% confidence interval (CI) = 72.1% to 76.7%] White vs. 57.0% [95% CI = 51.9% to 61.8%] Black) and acute lymphocytic leukemia (66.5% [95% CI = 61.4% to 71.0%] White vs. 44.4% [95% CI = 39.9% to 48.8%] Hispanic) were striking, and disparities remained even for cancers with excellent prognosis, such as testicular cancer (96.6% [95% CI = 95.9% to 97.2%] White vs. 88.7% [95% CI = 82.4% to 92.8%] Black). In adjusted analysis, being Black or Hispanic, living in high poverty neighborhoods, and having Medicaid, other government insurance, or no insurance at diagnosis were associated with all-cause mortality in both women and men (all two-sided p < 0.01).
Our study adds urgency to well-documented disparities in cancer survival in older adults by demonstrating persistent differences in relative survival and all-cause mortality in AYAs. Findings point to several areas of future research to address disparities in this unique population of cancer patients.