Improving Survival Among Adolescents and Young Adults With Cancer in the United States, 1975–2017: Long-Term Trends Across Age, Sex, and the HIV/AIDS Era

PURPOSE To compare cancer survival in the United States during the past half century in adolescent and young adult (AYA) patients of age 15-39 years with younger and older patients. METHODS Annual survival data were obtained from 8 US SEER regions during 1975-2017 for AYAs, younger (age 0-14 years), and older (age 40-59 and ≥65 years) populations. The average annual percent change (AAPC) in 5-year relative survival was determined with and without deaths from HIV/AID-associated malignancies that compromised overall cancer survival in males during the HIV/AIDS epidemic of 1981-1998. Joinpoint analysis identified time trends and statistical significances. RESULTS During 1975-1997, the AAPC in 5-year relative survival in AYAs was 0.66 (95% CI, 0.63 to 0.69), which was less than that in both younger, age <15 years, 0.93 (95% CI, 0.82 to 1.05) and older, age 40-64 years, 1.12 (95% CI, 0.10 to 1.14) patients. Subsequently, the 2000-2017 AAPC in AYAs was 0.47 (95% CI, 0.45 to 0.49), which was greater than that in both younger, age <15 years, 0.40 (95% CI, 0.34 to 0.45) and older, age 40-64 years, 0.43 (95% CI, 0.42 to 0.44) patients. In males, whose overall cancer survival was seriously compromised by the HIV epidemic in the 1980s and 1990s, much of the overall progress occurred as a result of the epidemic's cessation. Excluding HIV-associated cancers, however, showed even greater progress than the results for males and females considered together. CONCLUSION While compared with younger and older patients with cancer, American AYAs had the slowest improvement in 5-year relative survival before 1998, they since have had a greater improvement rate. Much of this progress can be attributed to national efforts led by NCI-funded cooperative groups to focus on AYA oncology.