Although adolescents with cancer can receive care in pediatric or adult institutions with survival often differing by location, little is known about relative healthcare utilization and costs among this patient population. “Adolescents and young adults (AYA) with cancer are often considered a forgotten group of patients—falling between the pediatric age range and older adults, two groups that have been a focus of considerable research,” says Paul Nathan, MD, MSc.
For a study published in the Journal of the National Cancer Institute, Dr. Nathan and colleagues sought to compare the costs of cancer care in children and adolescents. The researchers compared healthcare resource utilization (hospitalizations, emergency visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs. Patients were aged 15 to 18 years.
Among 1,356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during pre-diagnosis (14.9% vs 6.9%) as well as initial (95.1% vs 73.3%) and continuing phases (43.2% vs 34.4%) of care, but similar (96.1% vs 96.3%) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. In general, costs for caring for adolescents with cancer in pediatric centers was substantially higher than in adult centers, explains Dr. Nathan. Indeed, for all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153,926 vs $102,418 per 360 days; lymphoma: $65,025 vs $19,846, respectively).
The authors note that adolescents with acute lymphoblastic leukemia or pediatric-type sarcomas often have superior survival rates when treated in pediatric centers. In contrast, adolescents with adult-type malignancies, such as carcinomas, may experience better outcomes in adult centers.
“We need to explore whether the higher costs of care in pediatric centers reflected, in part, more intensive therapy and supportive care, and whether this is the explanation for the better survival outcomes observed in some cancer types,” says. Dr. Nathan.
Paul Nathan, MD, MSc, has indicated to Physician’s Weekly that he has no financial interests to disclose.
Nathan P, Bremner K, Liu N, et al. Resource Utilization and Costs in Adolescents Treated for Cancer in Pediatric vs Adult Institutions. J Natl Cancer Inst. 2018, July 19. [Epub ahead of print]. Available at https://academic.oup.com/jnci/advance-article-abstract/doi/10.1093/jnci/djy119/5056314?redirectedFrom=fulltext.