Does Treatment Setting Matter? Evaluating Resource Utilization for Adolescents Treated in Pediatric vs Adult Cancer Institutions
Menée au Canada à partir de données portant sur 1 356 adolescents atteints d'un cancer diagnostiqué entre 1995 et 2010, cette étude anayse les coûts associés à l'utilisation des soins et des services de santé (hospitalisations, recours aux services d'urgence, chirurgie ambulatoire, radiothérapie, test de diagnostic, etc), dans des établissements pédiatriques ou dans des établissements de santé pour adultes
Improvements in survival among adolescents and young adults (AYAs) with cancer have generally lagged behind pediatric and older adult cancer patients over the past decades (1). Addressing and improving health outcomes for this population are challenging and have been hampered by organizational and resource-related factors, including knowledge about the most effective treatment settings and regimens (2,3). Previous studies have demonstrated statistically significant variation in where AYAs with cancer are treated, with referral of AYAs to pediatric oncology diminishing greatly with increasing age, cancer type, and distance to pediatric oncology facilities (4–7). Recently, more aggressive pediatric-inspired treatment regimens for AYAs have shown clinically significant survival improvements relative to adult regimens in a variety of common cancers in this population, including acute lymphoblastic leukemia (8) and Hodgkin lymphoma (9). However, many factors, in addition to the regimen itself, can contribute to underlying differences in long-term survival and health-related quality-of-life outcomes among AYAs treated in pediatric vs adult settings. In this issue of the Journal, Nathan and colleagues (10) provide additional insights into our understanding of treatment differences for adolescents seen in pediatric vs adult cancer facilities, examining resource utilization and costs across the two settings. They use the population-based Ontario Cancer Registry and Pediatric Oncology Group of Ontario’s Networked Information System to evaluate adolescents age 15–17 years who were diagnosed with cancer from 1995 to 2010. Combining these cancer registries with comprehensive administrative databases to obtain more complete health care utilization and cost data, the authors examined differences between the two settings across a wide range of resources including hospitalizations, emergency department (ED) visits, surgeries, outpatient chemotherapy, radiation, laboratory tests, physician services, and home care. They additionally examined costs across the cancer care continuum from prediagnosis through terminal care. The authors concluded that among the 1356 patients age 15–17 years who were studied, the cost of caring for adolescents was predominately higher among those treated in pediatric compared with adult institutions—driven in part by higher hospitalization rates and longer hospital stays. Additionally, adolescents treated in the pediatric setting tended to seek more ED care immediately before diagnosis and during the initial treatment phase; these adolescents also used more home care services during initial treatment and survivorship. Higher hospitalization rates and longer lengths of stay in pediatric vs adult settings were also seen among different diagnoses, including leukemias, lymphomas, sarcomas, and germ cell tumors—but only during the initial treatment phase.