182808 Area vs. individual socioeconomic effects on survival in adolescents and young adults with hematopoetic cancer: A multi-level approach

Sunday, October 26, 2008

Erin Elizabeth Kent, PhD , Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD
Leonard Sender, MD , Department of Epidemiology, University of California, Irvine, Irvine, CA
Hoda Anton-Culver, PhD , Department of Epidemiology, Irvine, CA
According to a recent summary of the occurrence of cancers in U.S. adolescents and young adults (AYA), one in 168 individuals ages 15-30 develops invasive cancer (Bleyer, 2007). Bleyer and colleagues (2006) point out that AYA have 2.7 times increased risk of cancer as compared to younger persons and the growing deficit in survival improvement in this age group relative to all other age groups. Differences in survival among (AYA) diagnosed with leukemias and lymphomas have also been found to vary with neighborhood socioeconomic status (SES). In addition, Hispanic patients show worse survival than non-Hispanic whites. Here we lay out a framework for examining the specific factors which might predict prognostic success in AYA with hematopoetic cancer in California. We provide a description of the planned methodology to sample individuals in the California Cancer Registry from the five different neighborhood quintiles of SES to receive a home-mailed survey on the specific individual socioeconomic risk factors (using Oakes and Rossi's CAPSES measure), access to treatment, and other resources and challenges derived from focus groups with AYA cancer survivors and interviews with hospital social workers. We discuss methodological challenges and successes and provide recommendations for future registry-based survival analyses. Socioeconomic disparities appear to adversely influence survival of adolescents, and young adults with ALL independently of race, ethnicity, gender, hospital type and time from diagnosis and treatment onset. Further research will be conducted to examine which social, health and treatment factors are most important, and whether the results in California are generalizable.

Learning Objectives:
1. Recognize the need for targeted epidemiologic assessments of socioeconomic contributions to cancer outcomes in adolescents and young adults. 2. Identify differences in leukemia and lymphoma survival by levels of neighborhood socioeconomic status, particularly for certain race/gender/age groups. 3. List specific factors that seem to explain poorer cancer survival in young individuals with lower SES, including stage at diagnosis, access to care, health literacy, and general health status.

Keywords: Adolescent Health, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a graduate student working in the Department of Epidemiology and doing dissertation research on this topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.