Non-Hodgkin Lymphoma Survival Among Adolescents FREE

The risk of dying from non-Hodgkin lymphoma (NHL) has been found to be higher among young adults than children,¹ and mortality from all invasive cancers is higher among adolescents compared with other pediatric age groups.² We examined the extent to which the 5-year NHL survival rate varied by age group (child, adolescent, and young adult).

In an analysis of 2442 cases of NHL among US children (age, 0-14 years), adolescents (age, 15-19 years), and young adults (age, 20-29 years) diagnosed from 1992 through 2001 and reported to 13 Surveillance, Epidemiology and End Results registries, we assessed risk of death within 5 years of cancer diagnosis for members of each age group. We also assessed the effects of 9 independent variables (sex, race/ethnicity, NHL stage at diagnosis, year of diagnosis, histology, radiation treatment, poverty status, household income, and patient migration) on this risk. We modeled 5-year overall cause-specific survival with multivariate Cox proportional hazards to obtain hazard ratios (HRs) and their 95% confidence intervals (CIs). In the final model, we adjusted for NHL subtype, year of diagnosis, race/ethnicity, and NHL stage at diagnosis.

Adolescents were more likely to die within 5 years of NHL diagnosis compared with children (HR, 2.4; 95% CI, 1.7-3.3) (Table). Young adults were also more likely to die within 5 years of NHL diagnosis compared with children (HR, 3.1; 95% CI, 2.3-4.1). Patients with NHL aged 29 years or younger with stage III or stage IV disease were more likely to die within 5 years of diagnosis compared with those with stage I disease (HR, 1.7; 95% CI, 1.2-2.5; and HR, 3.2; 95% CI, 2.5-4.1, respectively).

We found that 5-year NHL survival rates were lower among adolescents and young adults than among children and lower among patients with advanced disease than among those with early disease. Adolescents are increasingly being recognized as a group with unique biological and psychosocial traits that may affect their cancer survival.³ The types and distribution of cancers among adolescents differ significantly from those among children and adults.² Factors that may contribute to adolescents and young adults having poorer NHL survival rates than children include a lower rate of enrollment in clinical trials, poorer adherence to treatment regimens, and less access to optimal cancer services.^4- 5 Only 10% to 15% of adolescents with cancer were enrolled in clinical trials from 1997 to 2003 compared with 60% of children with cancer.⁵ Issues associated with adolescents' transition from the dependence of childhood to the autonomy of adulthood, including disagreements with authority figures, confusion about responsibilities, lack of communication, and failure to accurately perceive the severity of their cancer and the risk it poses,⁴ may negatively affect the quality of cancer care they receive and their chances of survival. The NHL survival rate among young adults was also lower than that among children, and for many of the same reasons it was lower among adolescents, including lower rates of enrollment in clinical trials and less treatment at comprehensive cancer centers.⁵ Young adults are also more likely to be uninsured.⁵

The survival of all NHL patients is dependent on their receiving appropriate cancer therapy. Efforts to improve NHL survival rates among adolescents and young adults should include increasing their enrollment in clinical trials and improving their access to insurance and optimal cancer services.

Correspondence: Dr Tai, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS-K57, Atlanta, GA 30341 (cvn5@cdc.gov).

Author Contributions:Study concept and design: Tai, Pollack, Li, Steele, and Richardson. Acquisition of data: Townsend and Li. Analysis and interpretation of data: Tai, Pollack, Townsend, Li, and Richardson. Drafting of the manuscript: Tai, Pollack, Townsend, and Steele. Critical revision of the manuscript for important intellectual content: Tai, Pollack, Townsend, Li, and Richardson. Statistical analysis: Tai, Pollack, Townsend, and Li. Administrative, technical, and material support: Tai. Study supervision: Tai and Richardson.

Financial Disclosure: None reported.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.