Adolescents and young adults (AYAs) with cancer have a higher risk of early death if they have hematologic malignancies rather than solid tumors or central nervous system (CNS) cancers, according to research published in the Journal of the National Cancer Institute.
Researchers also found that early death — defined as death within 2 months of diagnosis — was influenced by sex, age at diagnosis, race/ethnicity, and insurance status.
Using the Surveillance, Epidemiology, and End Results database, the researchers examined data from AYAs (aged 15-39.99 years) diagnosed with cancer from January 2000 to December 2016. Of the 268,501 patients in this cohort, 3854 (1.4%) experienced early death.
The highest incidence of early death occurred in patients with hematologic malignancies (3.1%), followed by patients with CNS tumors (2.5%) and those with solid tumors (1.0%).
When the researchers looked at specific subtypes of cancer, they found the highest risk of death in patients diagnosed with liver or intrahepatic bile duct cancer (16.4%), unspecified malignant intracranial and intraspinal neoplasms (15.5%), acute myeloid leukemia (9.4%), gastric cancer (9.4%), osteosarcoma (7.7%), cancer of the trachea, bronchus, or lung (7.6%), and pancreatic cancer (7.5%).
The lowest risk of early death was seen in patients with thyroid carcinoma (0.1%), melanoma (0.2%), and breast cancer (0.3%), among others.
The researchers also discovered demographic characteristics associated with a higher incidence of early death. For instance, increasing age at diagnosis was associated with a higher risk of early death among male, but not female, patients.
Male patients experienced early death at a higher rate than female patients for hematologic malignancies (3.6% and 2.3%, respectively; P <.001), CNS tumors (2.8% and 2.2%; P =.02), and solid tumors (1.7% and 0.6%; P <.001).
Uninsured patients experienced early death at a higher rate than insured patients and patients with unknown insurance status for hematologic malignancies (5.5%, 2.3%, and 3.8%, respectively; P <.001), CNS tumors (4.2%, 1.8%, and 3.3%; P <.001), and solid tumors (2.5%, 0.8%, and 1.1%; P <.001).
Among patients with hematologic malignancies, Black patients (4.8%) experienced the highest rate of early death, followed by Hispanic (4.4%), Asian or Pacific Islander (3.1%), and White (2.1%) patients (P <.001).
Among those with CNS tumors, Hispanic patients (3.9%) had the highest rate of early death, followed by Black (3.2%), Asian or Pacific Islander (2.4%), and White (2.1%) patients (P <.001).
Among patients with solid tumors, Black patients (2.1%) again had the highest incidence of early death, followed by Asian or Pacific Islander (1.4%), Hispanic (1.2%), and White (0.7%) patients (P <.001).
“[F]uture research is needed to understand why certain AYA subgroups are at increased risk of death within 2 months of diagnosis, with a focus on AYAs with hematologic malignancies, Black males, and those who live in low-SES [socioeconomic status] areas and/or lack private health insurance,” the researchers concluded.
Berkman AM, Andersen CR, Hildebrandt MAT, et al. Risk of early death in adolescents and young adults with cancer: A population-based study. J Natl Cancer Inst. Published online January 23, 2023. doi:10.1093/jnci/djac206