Premium
Treatment and survival patterns for germ cell tumors among 13‐ to 24‐year olds in Yorkshire, UK
Author(s) -
Feltbower Richard G.,
Siller Catherine,
Woodward Emma,
McKinney Patricia A.,
Picton Susan V.,
Joffe Jonathan,
Stark Daniel P.
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22794
Subject(s) - medicine , poisson regression , germ cell tumors , incidence (geometry) , population , young adult , pediatrics , cancer , chemotherapy , demography , physics , environmental health , sociology , optics
Background Teenage and young adult (TYA) patient care can fall into gaps between adult and children's services. Increasingly UK TYA multi‐disciplinary teams manage germ cell tumors (GCT) in locally agreed collaborations and age ranges. Patterns of care are changing rapidly. However, between disciplines protocols define different assessment and management in GCT. We aimed to document changes in incidence, treatment, and survival since 1990, to record the baseline to which future trends can be compared. Procedure Details were extracted from the UK population‐based Yorkshire Specialist Cancer Register on 237 TYA aged 13–24 years diagnosed with a GCT between 1990 and 2004, followed‐up until 2009. Incidence and survival patterns were assessed using Poisson and Cox regression. Results Testicular (n = 190; 80%) and ovarian (n = 22; 9%) GCT were the most common malignancies, and 90% of GCT occurred aged 17–24 years. The overall incidence rate was 26.9 per million person years. Rates increased significantly by 4.0% (95% CI: 1.0–7.1%) per year on average. The most common treatment modality was surgery combined with chemotherapy (49%). Initial treatment changed significantly over time ( P = 0.003) and by age ( P = 0.005). There were significant differences in the management of stage 1 testicular tumors by age. Among 13‐ to 16‐year olds, 56% were treated exclusively in adult departments. Five‐year survival rates were 93–95% for gonadal GCT, and 70–75% for other sites. Survival did not differ by age ( P = 0.65) or period ( P = 0.41). Conclusions The age‐related differences observed in the approach to GCT treatment suggest a collaborative approach to the models of care among TYA is required. Pediatr Blood Cancer 2011;56:282–288. © 2010 Wiley‐Liss, Inc.