National survival trends of young adults with sarcoma

Lack of progress is associated with lack of clinical trial participation

Authors

  • Archie Bleyer M.D.,

    Corresponding author
    1. Divisions of Cancer Medicine and Pediatrics, The University of Texas M. D. Anderson Cancer Center; Houston, Texas
    2. Department of Pediatrics, The University of Texas Medical School, Houston, Texas
    3. The Children's Oncology Group, Arcadia, California
    • Unit 241, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030
    Search for more papers by this author
    • Fax: (713) 563-2957

  • Michael Montello Pharm.D.,

    1. Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
    Search for more papers by this author
  • Troy Budd,

    1. Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
    Search for more papers by this author
  • Scott Saxman M.D.

    1. Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
    Search for more papers by this author

  • This article is a US Government work and, as such, is in the public domain in the United States of America.

  • Presented in part at the Annual Meeting of the American Society of Clinical Oncology, Chicago, Illinois, May 31–June 1, 2003.

Abstract

BACKGROUND

Young adults with cancer in the U.S. have had less improvement in survival than either younger patients or older patients. The authors attempted to determine whether similar deficits have occurred in young adults with sarcomas and, if so, then why.

METHODS

In 38,144 young adults with sarcoma who were diagnosed during 1975–1998 and were followed by the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results Program, the average annual percent change in 5-year survival was derived as a function of patient age. National sarcoma treatment trial data were obtained on 3242 patients who were entered onto NCI-sponsored trials during 1997–2002.

RESULTS

1) For patients with bone and soft-tissue sarcomas, except Kaposi sarcoma (KS), the least survival improvement occurred between age 15 years and age 45 years. For patients with KS, the pattern was reversed, with the greatest survival increase occurring among patients ages 30–44 years. 2) The lowest participation rate in NCI-sponsored sarcoma treatment trials occurred in patients ages 20–44 years. For patients with KS, the highest accrual rate occurred in patients ages 35–44 years. 3) The age-dependent survival improvement and clinical-trial accrual patterns were correlated directly (soft-tissue sarcomas, P < 0.005; bone sarcomas, P < 0.05; KS, P = 0.06), regardless of whether the accrual profile demonstrated a decline or a peak (KS) during early adulthood.

CONCLUSIONS

The lack of survival prolongation in patients age 15–44 years in the U.S. with non-KS sarcomas may have been a result of their relative lack of participation in clinical trials. If this is true, then reversing the shortfall in survival among young adults with sarcomas, as was accomplished among patients with KS, should benefit from increased clinical trial availability, access, and participation. Cancer 2005. Published 2005 by the American Cancer Society.

Ancillary