Background: Younger adolescents and young adults (AYA) may receive care from either adult or pediatric oncologists. We explored patterns of care in this population and whether survival is associated with provider type. Methods: Utilizing the California Cancer Registry, we examined a cohort of 9,993 AYAs diagnosed with cancer aged 15 to 24 years from 1999 to 2008. Provider type (adult/pediatric) was determined by individual physician identifiers. For provider type, multivariable logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, diagnosis, and stage. For observed survival, Cox proportional hazard models were additionally adjusted for provider type. ORs and HR with 95% confidence intervals (95% CI) were determined. Results: Most patients saw adult providers (87.3% overall; 72.7% aged 15–19 years). Patients with acute leukemia, sarcoma, and central nervous system (CNS) malignancies more often saw pediatric providers [OR (95% CI) adult versus pediatric 0.48 (0.39–0.59), 0.74 (0.60–0.92), 0.76 (0.60–0.96), respectively]; those with germ cell tumors and other cancers, including carcinomas, more often saw adult providers [2.26 (1.72–2.98), 1.79 (1.41–2.27), respectively]. In aggregate and for most cancers individually, there was no survival difference by provider type [overall HR (95% CI) 1.00 (0.86–1.18)]. Higher survival was associated with pediatric providers for CNS malignancies [1.63 (1.12–2.37)] and rhabdomyosarcoma [2.22 (1.03–4.76)], and with adult providers for non-Hodgkin lymphoma [0.61 (0.39–0.96)]. Conclusions: Most AYAs 15 to 24 years old are treated by medical oncologists. In general, survival was not associated with provider type. Impact: Current patterns of care for this population support increased collaboration between medical and pediatric oncology, including joint clinical trials.

中文翻译：

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年轻青少年和年轻人的癌症护理模式和生存率：一项基于人群的回顾性队列研究

背景：年轻的青少年和年轻人 (AYA) 可能会接受成人或儿科肿瘤学家的护理。我们探索了该人群的护理模式以及生存率是否与提供者类型相关。方法：利用加州癌症登记处，我们检查了 1999 年至 2008 年间被诊断患有 15 至 24 岁癌症的 9,993 名 AYA 队列。提供者类型（成人/儿科）由个体医生标识符确定。对于提供者类型，多变量逻辑回归模型根据年龄、性别、种族/民族、社会经济地位、诊断和阶段进行了调整。对于观察到的生存，Cox 比例风险模型还针对提供者类型进行了调整。确定了具有 95% 置信区间 (95% CI) 的 OR 和 HR。结果：大多数患者看到了成人提供者（总体为 87.3%；15-19 岁的患者为 72.7%）。患有急性白血病、肉瘤和中枢神经系统 (CNS) 恶性肿瘤的患者更常就诊于儿科医师 [OR (95% CI) 成人与儿科 0.48 (0.39–0.59)、0.74 (0.60–0.92)、0.76 (0.60–0.96) ， 分别]; 那些患有生殖细胞肿瘤和其他癌症（包括癌）的人更经常看到成人提供者 [分别为 2.26 (1.72–2.98), 1.79 (1.41–2.27)]。总体而言，对于大多数癌症个体而言，不同提供者类型的生存率没有差异 [总体 HR (95% CI) 1.00 (0.86–1.18)]。较高的存活率与中枢神经系统恶性肿瘤 [1.63 (1.12–2.37)] 和横纹肌肉瘤 [2.22 (1.03–4.76)] 的儿科提供者以及非霍奇金淋巴瘤的成人提供者 [0.61 (0.39–0.96)] 相关。结论：大多数 15 至 24 岁的 AYA 都由医学肿瘤学家治疗。一般来说，存活率与提供者类型无关。