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Lifelong, guideline-based monitoring for late effects is recommended for childhood cancer survivors (CCS). We examined rates of receiving surveillance tests among at-risk young adult CCS in a population-based study (n = 253; 50% Hispanic/Latino; mean post-treatment interval 14.5 years, range: 5-22). Adherence rates were 36.1%, 31.9%, and 36.4% among those indicated for cardiac (n = 119), thyroid (n = 68), and breast (n = 66) surveillance, respectively, indicating that poor surveillance among long-term CCS is widespread. Receipt of any of these surveillance tests was positively associated with being in follow-up care, having any health insurance (vs. none), and receiving education about need for follow-up with surveillance (all p-values less than .05).

Evidence suggests neighborhood-level factors contribute to cancer outcomes, although most research focuses on pediatric and adult populations. Using population-based data from the Texas Cancer Registry, we examined neighborhood-level social vulnerability, a composite measure of 14 census tract-level social risk factors, and survival among 112 142 adolescents and young adults with cancer (AYAs, age 15-39 years). We estimated 1-, 5-, and 10-year overall survival by quintile of social vulnerability and used Cox proportional hazards models (2-sided significance testing) to estimate the association between social vulnerability and all-cause mortality. Survival decreased as social vulnerability increased; for example, 5-year survival was 86.5% (95% confidence interval [CI] = 85.1 to 87.0) in the least vulnerable quintile compared to 74.0% (95% CI = 73.4 to 74.5) in the most vulnerable quintile. Social vulnerability was associated with all-cause mortality in adjusted models (highest vs lowest quintile: adjusted hazard ratio [aHR] = 1.55, 95% CI = 1.48 to 1.63). Achieving equity in AYAs' survival requires interventions to address neighborhood disparities. [ABSTRACT FROM AUTHOR]

Background: The recognition of thin marginal spinal syndesmophytes is important, in part due to their association with non-traumatic or mildly traumatic vertebral fractures. Purpose: To determine a lower limit on the prevalence of marginal spinal syndesmophytes using chest radiographs. Material and Methods: We conducted a retrospective analysis of 500 chest radiographs, assessing the prevalence of thin marginal syndesmophytes, bridging or near-bridging osteophytes, and flowing paravertebral ossifications in the thoracic intervertebral discs among individuals aged 16 years and older in a North American city. Results: Among the 500 participants, we observed that thin vertical marginal syndesmophytes were present in 17 (3.4%) cases, bridging or near-bridging osteophytes were present in 126 (25.2%) cases, and flowing paravertebral ossifications were present in 37 (7.4%) cases. Out of the 17 participants with thin marginal syndesmophytes, 10 exhibited a bamboo-like spine appearance, defined as the presence of ≥4 contiguous levels of bridging marginal syndesmophytes. Analysis of syndesmophyte distribution per vertebral level indicated a higher frequency of involvement in the mid to lower thoracic spine, maximal at T9/10. Conclusions: The presence of thin marginal syndesmophytes in the thoracic spine on routine chest radiographs is substantially more prevalent than would be anticipated based on the existing literature. The feasibility of reliably identifying these syndesmophytes in the spine and the impact of this on morbidity should be further investigated due to their association with advanced ankylosing spondylitis and their susceptibility to fractures. [ABSTRACT FROM AUTHOR]

Simple Summary: Cladribine is a chemotherapy used in combination with other chemotherapy drugs in adult patients with acute myeloid leukemia (AML) who relapse or are nonresponsive to treatment. It appeared to work well and is now used for newly diagnosed adult patients. While it is commonly used in adults, it has not been used routinely in children. We looked at medical records of pediatric and adolescent patients treated for AML at MD Anderson to analyze its safety and how well it works against AML. It was found to be safe and well tolerated in these patients and also showed improved survival outcomes. About half of the patients responded to cladribine either by itself or with other chemotherapy agents. This review also highlighted its safety in combination with other agents. We found these combinations to be well tolerated and could provide additional options for pediatric providers who are treating relapsed AML. Background: Cladribine-based combination chemotherapy has demonstrated promising efficacy in patients with relapsed/refractory adult acute myeloid leukemia (AML), prompting its increased utilization in the frontline; in pediatrics, it has been typically reserved for relapsed or refractory cases. While fludarabine has been used more commonly as a purine analog in intensive regimens, cladribine may be an important alternative. Methods: We performed a retrospective study at MD Anderson Cancer Center from January 2015 to July 2023, which included patients aged 1–21 years with refractory or relapsed AML who received cladribine outside of a transplant conditioning. Results: A total of 30 patients were included, with a median age of 20 years (range, 2–21), and 55% being male. Similar to adults, cladribine exhibited good tolerability in pediatric and adolescent patients, with the most common adverse events being febrile neutropenia and myelosuppression. The most common grade 3 or 4 adverse events included febrile neutropenia (55%) and sepsis (26%), and there were no treatment discontinuations due to adverse events. Among patients with a median number of 2 (0–7) prior treatments, the overall response rate (CR/CRi) was 45%, and median event-free and overall survival were 6 and 12 months, respectively. Disease progression resulted in 4 deaths within 30 days of treatment. Conclusions: Cladribine was tolerated in pediatrics. No new safety signals were seen with cladribine regimens in this cohort. Response assessment is limited due to the heavily pretreated cohort. Further prospective studies are warranted on the safety and efficacy of cladribine and establish its role in pediatric, adolescent, and early young adult patients with AML. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Plain Language Summary The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19–25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?The ACE DCE 7‐year age range of 19–25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7‐year age spans: ages 12–18 and 26–32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative survival data of patients who were diagnosed with cancer were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results regions representing 42%–44% of the country.Joinpoint analysis identified the DCE‐eligible cohort as the only age group of the three groups evaluated that have had improvements in both cancer survival and death rate trends after ACA implementation and that 2010, the year the ACA was passed, was the inflection year for both survival and deaths. By 6 years, the relative survival after cancer diagnosis was 2.6 and 3.9 times greater in the DCE‐eligible age group than in the younger and older control groups, respectively (both p < .001), and the cancer death rate in the DCE‐eligible age group improved 2.1 and 1.5 times greater than in the younger and older control age groups, respectively (both p < .01).During the first decade of the ACA, eligible young adults with cancer have had significantly improved survival and mortality. Additional policies expanding insurance coverage and enabling earlier cancer diagnosis among young adults are needed. The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19–25 years to remain on their parents' health insurance plans until age 26 years. The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE‐eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more. During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer. Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults. The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19–25 years to remain on their parents' health insurance plans until age 26 years.The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE‐eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more.During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer.Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults. [ABSTRACT FROM AUTHOR]

Background The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. Methods Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility—namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. Results Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). Conclusions Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. ClinicalTrials.gov NCT05620979 [ABSTRACT FROM AUTHOR]

Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Fertility after cancer is a top concern for adolescents and young adults with cancer (AYAs) (15–39 years old at diagnosis). The authors characterized live births after cancer by race and ethnicity ("race/ethnicity") in a population‐based sample of female AYAs. Methods: This study used Texas Cancer Registry data linked to birth certificates (1995–2016) to estimate cumulative incidence of live birth, based on first live birth after cancer, and compared differences by race/ethnicity. Proportional subdistribution hazards models were used to estimate associations between race/ethnicity and live birth, adjusted for diagnosis age, cancer type, stage, year, and prior live birth, overall and for each cancer type. Results: Among 65,804 AYAs, 10‐year cumulative incidence of live birth was lower among non‐Hispanic Black AYAs than other racial/ethnic groups: 10.2% (95% confidence interval [CI], 9.4–10.9) compared to 15.9% (95% CI, 14.1–17.9) among Asian or Pacific Islander, 14.7% (95% CI, 14.2–15.3) among Hispanic, and 15.2% (95% CI, 14.8–15.6) among non‐Hispanic White AYAs (p <.01). In the adjusted overall model, Black AYAs were less likely to have a live birth after cancer than all other groups. In adjusted models for each cancer type, live birth was significantly less likely for Black AYAs with gynecologic cancers or lymphomas (compared to White AYAs) or thyroid cancers (compared to Hispanic AYAs). Conclusion: Black AYAs are less likely than AYAs of other races/ethnicities to have a live birth after cancer, in contrast to patterns of live birth in the general population. Research and action to promote childbearing equity after cancer are imperative. The authors used Texas Cancer Registry data linked to live birth certificates (1995–2016) to characterize live births after cancer by race and ethnicity ("race/ethnicity") among females diagnosed with cancer as adolescents and young adults (AYAs) (15–39 years old at diagnosis). Overall and within certain cancer types, Black AYAs were less likely than AYAs of other races or ethnicities to have a live birth after cancer, in contrast to general population birth patterns. [ABSTRACT FROM AUTHOR]

Background: Survivors of adolescent and young adult (AYA) cancer experience significant psychological distress and encounter barriers to accessing mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes among AYA survivors, and none have compared outcomes within a racially minoritized population. Methods: National Health Interview Survey data (2010–2018) were analyzed that identified non‐Hispanic Black (hereafter, Black) survivors of AYA cancer and age‐ and sex‐matched Black noncancer controls. Sociodemographic factors, chronic health conditions, modifiable behaviors (smoking and alcohol use), and psychological outcomes were assessed with χ2 tests. Logistic regression models, adjusted for survey weights, were used to evaluate the odds of psychological distress by cancer status after adjusting for covariates. Interactions between variables and cancer status were investigated. Results: The study included 334 Black survivors of AYA cancer and 3340 Black controls. Compared to controls, survivors were more likely to report moderate/severe distress (odds ratio [OR], 1.64; p <.001), use mental health care (OR, 1.53; p =.027), report an inability to afford mental health care (OR, 3.82; p <.001), and use medication for anxiety and/or depression (OR, 2.16; p =.001). Forty‐one percent of survivors reported moderate/severe distress, and only 15% used mental health care. Among survivors, ages 18–39 years (vs. 40–64 years) and current smoking (vs. never smoking) were associated with the presence of moderate/severe distress. Among survivors with distress, high poverty status was associated with reduced utilization of mental health care. Conclusions: A cancer diagnosis for a Black AYA is associated with greater psychological distress within an already vulnerable population. Black survivors of adolescent and young adult cancer have higher levels of psychological distress than Black individuals without a history of cancer and are more likely to report an inability to afford mental health care. There is a gap in receipt of mental health care among Black survivors, with approximately 40% of survivors reporting moderate/severe distress and only 15% reporting a mental health care visit. [ABSTRACT FROM AUTHOR]

Background Neighborhood socioeconomic deprivation has been linked to adverse health outcomes, yet it is unclear whether neighborhood-level social determinants of health (SDOH) measures affect overall survival in adolescent and young adult patients with cancer. Methods This study used a diverse cohort of adolescent and young adult patients with cancer (N = 10 261) seen at MD Anderson Cancer Center. Zip codes were linked to Area Deprivation Index (ADI) values, a validated neighborhood-level SDOH measure, with higher ADI values representing worse SDOH. Results ADI was statistically significantly worse (P  < .050) for Black (61.7) and Hispanic (65.3) patients than for White patients (51.2). Analysis of ADI by cancer type showed statistically significant differences, mainly driven by worse ADI in patients with cervical cancer (62.3) than with other cancers. In multivariable models including sex, age at diagnosis, cancer diagnosis, and race and ethnicity, risk of shorter survival for people residing in neighborhoods with the least favorable ADI quartile was greater than for individuals in the most favorable ADI quartile (hazard ratio = 1.09, 95% confidence interval = 1.00 to 1.19, P  = .043). Conclusion Adolescent and young adult patients with cancer and the worst ADI values experienced a nearly 10% increase in risk of dying than patients with more favorable ADI values. This effect was strongest among White adolescent and young adult survivors. Although the magnitude of the effect of ADI on survival was moderate, the presence of a relationship between neighborhood-level SDOH and survival among patients who received care at a tertiary cancer center suggests that ADI is a meaningful predictor of survival. These findings provide intriguing evidence for potential interventions aimed at supporting adolescent and young adult patients with cancer from disadvantaged neighborhoods. [ABSTRACT FROM AUTHOR]