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.