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Impact of Locus of Care on Outcomes in Adolescents and Young Adults with Osteogenic sarcoma and Ewing Sarcoma treated at Pediatric versus Adult Cancer Centers: An IMPACT Cohort Study
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  • Mohammadreza Mortazavi,
  • Nancy Baxter,
  • Sumit Gupta,
  • Abha Gupta,
  • Cindy Lau,
  • Chenthila Nagamuthu,
  • Paul Nathan
Mohammadreza Mortazavi
The Hospital for Sick Children

Corresponding Author:[email protected]

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Nancy Baxter
The University of Melbourne School of Population and Global Health
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Sumit Gupta
The Hospital for Sick Children
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Abha Gupta
The Hospital for Sick Children
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Cindy Lau
Institute for Clinical Evaluative Sciences
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Chenthila Nagamuthu
Institute for Clinical Evaluative Sciences
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Paul Nathan
The Hospital for Sick Children
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Abstract Background: Location of cancer care (LOC: pediatric versus adult center) impacts outcomes in adolescents and young adults (AYA) with some cancer types. Data on impact of LOC on survival in AYA with osteogenic sarcoma (OGS) and Ewing sarcoma (EWS) are limited. Objectives: To compare differences in demographics, disease/treatment characteristics, and survival in a population-based cohort of AYA with OGS or EWS treated at pediatric versus adult centers Methods: The IMPACT Cohort captured demographic, disease, and treatment data for all AYA (15-21 years old) diagnosed with OGS and EWS in Ontario, Canada between 1992-2012. Patients were linked to provincial administrative healthcare databases. Outcomes were compared between patients treated in pediatric versus adult centers using appropriate statistical methods. Results: 137 AYA were diagnosed with OGS (LOC: 47 pediatric, 90 adult) and 84 with EWS (LOC: 38 pediatric, 46 adult). AYA treated at pediatric centers were more likely to be enrolled in a clinical trial (OGS 55% vs 1%, [p<0.001]; EWS 53% vs 2%, [p<0.001]) and received higher cumulative chemotherapy doses. Five-year event-free survival (EFS ± Standard Error) in OGS and EWS were 47% ± 4 and 43% ± 5, respectively. In multivariable analysis, the impact of LOC (pediatric vs adult center) on EFS in OGS (adjusted hazard ratio [HR] 1.15, 95% CI 0.58-2.27, P=0.69) and EWS (adjusted HR 1.82, 95% CI 0.97-3.43, P=0.06) were not statistically significant. Conclusion: Outcomes did not differ by LOC suggesting that AYA with bone tumors can be treated at either pediatric or adult centers.
25 Aug 2021Submission Checks Completed
25 Aug 2021Assigned to Editor
25 Aug 2021Submitted to Pediatric Blood & Cancer
26 Aug 2021Reviewer(s) Assigned
13 Sep 2021Review(s) Completed, Editorial Evaluation Pending
14 Sep 2021Editorial Decision: Revise Minor
08 Oct 2021Submission Checks Completed
08 Oct 2021Assigned to Editor
08 Oct 20211st Revision Received
08 Oct 2021Reviewer(s) Assigned
22 Oct 2021Review(s) Completed, Editorial Evaluation Pending
23 Oct 2021Editorial Decision: Accept