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

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.