First Tool to Assess Impact of Co-illnesses in Young Cancer Patients
Concurrent but unrelated diseases in adolescents and young adults (AYA) with cancer have been identified and documented. The index, published in Cancer Epidemiology, Biomarkers & Prevention (doi:10.1158/1055-9965.EPI-15-0401), measures the impact of other medical conditions on health care services needs and the general health status of this patient population.
Cancer is the leading cause of disease-related death in adolescents and young adults, and is diagnosed in nearly 70 000 persons age 15 to 39 years annually in the United States. Although strides have been made in improving the survival of children and adults with cancer, these improvements are lower in patients with a cancer diagnosis at age 15 to 39 years.
Little or no improvement in cancer survival rates has been achieved in this age group for decades. These patients too frequently fall between pediatric and adult oncology. The study, funded by the National Cancer Institute (NCI), is part of the Adolescent & Young Adult Health Outcomes & Patient Experience (AYA HOPE) Study designed to address the disparities.
Previous studies show that having comorbidities adversely affect treatment, quality of life, service needs, and survivorship care in adult cancer survivors. Co-illnesses may increase the toxicity of specific treatments, increase hospitalizations, create difficulties with treatment, and lead to higher health care costs and death.
Co-illnesses are self-reported by 30% of AYA patients at the time of their cancer diagnosis, and 56% to 75% of AYA cancer survivors need certain kinds of health care services, such as pain management services, mental health services, or support groups. Whether these other medical conditions predict health services needs among AYA cancer survivors is unclear, however, because little such information is available in the literature.
"The development of the AYA HOPE Comorbidity Index serves as a starting point to quantify the breadth of comorbidities AYA cancer survivors may face as they progress through treatment and survivorship," noted Xiao-Cheng Wu, MD, MPH, professor of Epidemiology and director of Louisiana State University (LSU) Health New Orleans Louisiana Tumor Registry at the LSU Health New Orleans School of Public Health. LSU researchers developed the index in collaboration with investigators from the NCI and cancer registries of Surveillance, Epidemiology, and End Results Program.
Of the 485 patients studied, 14.6% had more than 2 additional illnesses based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices developed and used primarily for adult and pediatric cancer patients, were 8.2% and 5.8%, respectively.
Prevalence of cardiovascular, endocrine, gastrointestinal, and neurologic conditions was higher with the AYA HOPE Index than the other 2 indices developed for older patients. Special needs were reported by 40% of AYA patients, particularly for mental health services (25.2%) and support groups (17.7%). Having more than two comorbidities on the AYA index was associated with higher mental health service needs and with fair/poor self-reported health status.
"The AYA HOPE Index can help identify patients' additional service needs early in therapy and may be a helpful tool to predict service needs with the goal of improving outcomes in this group," concluded LSU Health New Orleans pediatric oncologist Pinki K. Prasad, MD, MPH, assistant professor of Pediatrics in the School of Medicine.