Pediatric Physician Management as a Predictor of Clinical Trial Enrollment in Adolescent and Young Adult Cancer Patients

Purpose: The Adolescent and Young Adult (AYA) gap describes the drop-off in survivorship improvement among 15-39-year-olds compared with patients with cancer under 15 or over 39. A large body of literature explores why this population experiences lower rates of trial enrollment, an issue of particular importance since this single factor is thought to have the greatest impact on the decrease in survivorship. The purpose of this research is primarily to identify whether or not AYA patients within a large academic center who were treated by a pediatric specialist were more likely to be enrolled in a clinical trial. Methods: A retrospective cohort study was conducted by chart review of AYA cancer patients within a large academic institution diagnosed from 2014 to 2016. Information, including physician specialty, sex, cancer subtype, age, and ethnicity were extracted and analyzed in relation to enrollment data from the clinical trials office. Results: Patients managed by a pediatric specialist were over 10 times more likely (p < 0.01) than those treated by adult specialists to be enrolled in a clinical trial. When stratified by cancer subtype, pediatric specialist management still predicted trial enrollment in subtypes more common in younger patients, including germ cell and osseous neoplasms, leukemia, and lymphoma. Neither age, sex, nor ethnicity correlated significantly with enrollment. Conclusion: These data not only depict the necessity of abandoning traditional age cutoffs when dealing with AYA cancer, but also reveal the need for further study to understand and ultimately rectify the discrepancy between pediatric and adult utilization of clinical trial enrollment.