Adolescent cancer patient referral patterns in British Columbia

Abstract

Recent studies have suggested that adolescent cancer may have better survival outcomes when treated at paediatric centres, which better emphasize enrolment in clinical trials and have more capacity to support the social and emotional needs of adolescents. This study investigated 616 cancer cases in adolescents aged 15-18 from 1995 to 2010 in British Columbia, Canada with data from the Childhood, Adolescent, and Young Adult Cancer Survivors Research (CAYACS) Program of the BC Cancer Research Agency (BCCA). This study examined whether referrals to the adult centres BC Children’s Hospital (BCCH) or BCCA were influenced by age, socioeconomic status, rurality, seasonality, radiotherapy treatment, different diagnoses based on the International Classification of Childhood Cancer (ICCC), and driving time to each centre. Between 1995 and 2010, only 27% of adolescent cancer patients in BC were referred to the BCCH, the only paediatric oncology centre in BC. Rural patients might have limited accessibility to BCCH, despite referral, due to travel restrictions and costs. As a result, patients are less likely to be referred to their closest cancer treatment centre as driving time increases (OR 0.995, P= 1.9e-10). Odds ratios of each modifier to BCCA or BCCH were calculated using univariate and multivariate logistic regression models in R Studio 3.5.1. Overall, 80% of younger adolescent (age 15-16) were referred to BCCH and only 14% of older adolescents (age 17-18) were referred to BCCH, which suggested that older adolescents were less likely than younger adolescents to be referred to BCCH (P= <2e-16). Additionally, leukaemia and Central Nervous System (CNS) cancer patients were more likely than all other patients to be referred to BCCH (P= 0.0014). The study of referral patterns is an essential factor when determining adolescent cancer survival rate.