QUESTION ASKED: Does location of inpatient treatment throughout therapy in children and young adults with acute lymphoblastic leukemia impact long-term survival, complications, and costs? SUMMARY ANSWER: We found that inpatient treatment received at a specialized cancer center throughout therapy is associated with superior survival in both children and young adults. While the incidence of complications was similar by location of care, hospitalization costs were significantly higher for patients receiving all treatment at a specialized cancer center. WHAT WE DID: Using population-based data from the California Cancer Registry that are linked to statewide hospitalizations, we examined the impact of the location of inpatient care throughout the full course of therapy on potential treatment-related complications and survival in children (0-18 years) and young adults (19-39 years) with acute lymphoblastic leukemia. Furthermore, given that specialized cancer centers may be more expensive than community hospitals, we evaluated the cost of inpatient treatment by location of care. WHAT WE FOUND: Our study demonstrates that receiving all inpatient treatment at a specialized cancer center is associated with superior leukemia-specific and overall survival in children and young adults. However, access to care at a specialized cancer center does not appear uniform insofar as young adults and those of African American and Hispanic race/ethnicity are less likely to receive all care at a specialized cancer center. Given the considerable impact that care at a specialized cancer center may have on leukemia survival, further research should explore how to improve access for these groups of patients. BIAS, CONFOUNDING FACTORS: Our study lacked details on specific treatment and biological factors (such as minimal residual disease, etc) to consider in our propensity scores and survival analyses. As a result, there may be residual confounding factors from the imbalance in baseline characteristics among patients treated at specialized cancer centers versus those treated at nonspecialized cancer centers. The use of propensity score–weighted models mitigated this bias; therefore, it is less likely that the differences in measured baseline characteristics could account for the difference noted in survival outcomes. However, this database allows for population-level analysis of sociodemographic and clinical factors impacting survival that have not been previously described. REAL-LIFE IMPLICATIONS: Given the associated improvement in survival seen with patients treated at a specialized cancer center, our findings support the clinical recommendation that children and young adult patients with this complex and relatively rare diagnosis be referred to and treated at specialized cancer centers.
ASJC Scopus subject areas
- Health Policy