Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia

Background: Individuals diagnosed with acute lymphoblastic leukemia (ALL) between adolescents and young adults aged 15-39 years face poor survival and unique challenges. We evaluated facility-level factors and guideline-concordant care among adolescents and young adults with ALL at National Cancer Institute Community Oncology Research Program (NCORP) practices. Methods: We assembled a retrospective cohort of adolescents and young adults aged 15-39 years with ALL treated at participating NCORPs between 2012 and 2016. NCORPs abstracted patient data and completed facility-level questionnaires for each clinical facility (study-defined criteria). The central review committee adjudicated whether treatment was concordant with adolescent and young adult–specific National Comprehensive Cancer Network ALL guidelines (ie, pediatric-inspired therapy or clinical trial). Guideline-concordant care was described by age, facility model (adult/internal medicine, pediatric, mixed [pediatric services within a general hospital]), and average annual adolescents and young adult ALL volume. Generalized linear mixed effects models estimated the odds of guideline-concordant care. Results: Adolescents and young adults receiving guideline-concordant care were younger (n ¼ 196; median ¼ 19.5 years) than those who did not (n ¼ 31; median ¼ 32.1 years). Guideline-concordant care was observed in many adolescents and young adults aged 22-39 years (68.8%), and nearly universal in those aged 15-21 years. In multivariable analyses, adolescents and young adults at adult/internal medicine clinical facilities had lower odds of guideline-concordant care (odds ratio ¼ 0.02, 95% confidence interval ¼ 0.0 to 0.18); there was no statistically significant association between annual adolescent and young ALL volume and receiving guideline-concordant care. Guideline-concordant care was observed more often in adult/internal medicine and/or mixed clinical facilities with communication between adult or pediatric counterparts, adolescents and young adult ALL clinical pathways, and/or adolescent and young adult–specific meetings. Conclusion: Guideline-concordant care among adolescents and young adults with ALL (specifically pediatric-inspired therapy) at NCORPs is associated with facility model (adult/internal medicine) but not adolescent and young adult ALL volume. Strategies to improve guideline-concordant care could include facilitating communication and clinical pathways at adult/internal medicine clinical facilities treating adolescent and young adult ALL.