Impact of Locus of Care on Outcomes in Adolescents and Young Adults with
Osteogenic sarcoma and Ewing Sarcoma treated at Pediatric versus Adult
Cancer Centers: An IMPACT Cohort Study
Abstract
Abstract Background: Location of cancer care (LOC: pediatric versus
adult center) impacts outcomes in adolescents and young adults (AYA)
with some cancer types. Data on impact of LOC on survival in AYA with
osteogenic sarcoma (OGS) and Ewing sarcoma (EWS) are limited.
Objectives: To compare differences in demographics, disease/treatment
characteristics, and survival in a population-based cohort of AYA with
OGS or EWS treated at pediatric versus adult centers Methods: The IMPACT
Cohort captured demographic, disease, and treatment data for all AYA
(15-21 years old) diagnosed with OGS and EWS in Ontario, Canada between
1992-2012. Patients were linked to provincial administrative healthcare
databases. Outcomes were compared between patients treated in pediatric
versus adult centers using appropriate statistical methods. Results: 137
AYA were diagnosed with OGS (LOC: 47 pediatric, 90 adult) and 84 with
EWS (LOC: 38 pediatric, 46 adult). AYA treated at pediatric centers were
more likely to be enrolled in a clinical trial (OGS 55% vs 1%,
[p<0.001]; EWS 53% vs 2%, [p<0.001]) and
received higher cumulative chemotherapy doses. Five-year event-free
survival (EFS ± Standard Error) in OGS and EWS were 47% ± 4 and 43% ±
5, respectively. In multivariable analysis, the impact of LOC (pediatric
vs adult center) on EFS in OGS (adjusted hazard ratio [HR] 1.15,
95% CI 0.58-2.27, P=0.69) and EWS (adjusted HR 1.82, 95% CI 0.97-3.43,
P=0.06) were not statistically significant. Conclusion: Outcomes did not
differ by LOC suggesting that AYA with bone tumors can be treated at
either pediatric or adult centers.