Improvements in survival among adolescents and young adults (AYAs) with cancer have lagged behind pediatric and older adult cancer patients over the past decades. Delving deeper into the disparity, the Journal of the National Cancer Institute recently featured a study examining the treatment differences for adolescents seen in pediatric versus adult cancer facilities in Ontario, Canada. The study showed that the cost of treating adolescents in pediatric institutions was higher based in part on increased hospitalization rates and longer stays; more emergency department care; and greater use of home care services compared to those treated in adult cancer centers.
In response, School of Public Health researcher Helen Parsons published an editorial in the journal calling for more research into the role treatment setting plays in resource utilization and health outcomes for AYA cancer patients — especially in the U.S.
“I was most surprised that the study showed resource use may be driven just as much by care setting as an individual’s cancer diagnosis,” says Parsons. “It highlights that, even among patients with similar diagnoses, a variety of approaches are taken to treat the same cancer in pediatric versus adult treatment centers.”
In the editorial, Parsons highlighted that pediatric cancer therapies are often more complex than adult approaches, resulting in longer initial inpatient stays. She also noted that other recent studies have demonstrated that AYA cancer patients appear to experience better health outcomes when treated in pediatric settings. Additionally, Parsons stated that pediatric facilities frequently offer more social and family services, which could lengthen stays to ensure the behavioral needs of patients are addressed before discharge.
Parsons said the Canadian study has many strengths, but more work is required to fully understand the role of the treatment setting in AYA health care utilization and outcomes outside of Ontario. Given the critical differences in health care delivery and payment models in Canada and the United States, it is important to conduct similar studies in the U.S. to confirm these findings.
“This study is a great first step in understanding how treatment settings may influence care for adolescents with cancer,” says Parsons. “It would be great for future studies to get at the subtlety underlying these differences and how they influence outcomes along the continuum of care.”