Epidemiology of Cancer Survivorship among Young and Emerging Adults
Creators: name: Perlman, Katherine Lee
Publisher: name: DigitalHub. Galter Health Sciences Library & Learning Center
Year: 2019
Subjects: subject: cancer survivorship
subject: young adults
subject: Cancer Survivors
subject: Young Adult
subject: Epidemiology
subject: United States

description: Background: Each year in the United States, an estimated 70,000 incident cancer cases are diagnosed among the young and emerging adult (YEA) population, and cancer is one of the top five leading causes of death in this age group. The YEA cancer population consists of those diagnosed with cancer between ages 18-39. YEA cancer patients present with unique risk factors for late effects of cancer treatment due to their transitional life status as they are undergoing social, emotional, and developmental transitions during the period of their cancer diagnosis, treatment, and survivorship. The goal of this study is to better understand the unique epidemiological factors in this population to improve care recommendations.Methods: Data was collected using the Northwestern Enterprise Data Warehouse (EDW), which contains medical records on YEA cancer survivors treated in the Northwestern Hospital system. Participants were eligible if they were diagnosed with any cancer in the Northwestern Hospital system between ages 18-39 and were diagnosed between 1/1/2000 and 1/1/2019. The dataset contained information for 14,552 patients including the patients study ID, gender, ethnicity, race, cancer diagnosis date, cancer type, age at diagnosis, secondary cancer, date of death, cerebrovascular disease, coronary artery disease, diabetes, heart failure, hyperlipidia, hypertension, peripheral arterial disease, and renal failure. Frequency analyses were used to determine distribution of each cancer type in the cohort and each cancer type by gender. Mann Whitney U test was used to determine mean age at diagnosis for each cancer type. Frequency distribution was used to determine racial and ethnic demographic distribution among the five most common cancers. Logistic regression was used to determine odds of developing comorbidities (heart failure, hyperlipidia, hypertension, secondary cancer). Survival analyses were conducted using Kaplan-Meier Survival Curves and Cox Proportional Hazards Models for breast cancer and lymphoma patients and time to hypertension diagnosis.Results: The most prevalent cancers in this population are breast, lymphoma, thyroid, melanoma, and brain and nervous system. Compared to non-breast YEA cancer survivors, breast cancer patients had a significantly higher odds of a secondary cancer diagnosis (OR= 2.4, 95% CI= 2.2-2.6). Compared to non-lymphoma YEA cancer survivors, lymphoma patients had a significantly higher odds of heart failure diagnosis (OR= 2.2, 95% CI= 1.7-3.0), hyperlipidia diagnosis (OR= 1.6, 95% CI= 1.4-1.9), and hypertension diagnosis (OR= 1.2, 95% CI= 1.1-1.4). Thyroid cancer patients had a significantly higher odds of a secondary cancer diagnosis (OR= 1.4, 95% CI= 1.2-1.5) compared to non-thyroid YEA cancer survivors. Kaplan-Meier estimates showed that race and secondary cancer status may play a role in time to hypertension diagnosis in YEA breast cancer patients. However, in Cox Proportional Hazards model, race and secondary cancer status had no impact on time to hypertension diagnosis. For lymphoma patients, Kaplan-Meier estimates showed that gender, race, and secondary cancer status may play a role in time to hypertension diagnosis. However, Cox Proportional Hazards model showed no impact of these variables on time to hypertension diagnosis.Conclusions: This study provides important public health implications by identifying the most prevalent cancers, mean age at diagnosis, and risk of future comorbidities among YEA cancer survivors in the Northwestern Medicine health system. It also provides evidence for possible factors impacting survival in this population.