UC Davis Comprehensive Cancer Center joined a first-of-its-kind study conducted by researchers at multiple institutions in California to study adolescent and young adult (AYA) cancer patients. The research found that young cancer survivors face significantly higher risks of developing chronic medical conditions compared to their peers without cancer.
The findings were published in Cancer, the journal of the American Cancer Society. Results underscore the urgent need for long-term survivorship care and proactive health management in this growing population.
Researchers found that by five years postdiagnosis, the cumulative incidence of chronic conditions was highest for:
- Thyroid issues (17.4%)
- Respiratory problems (6.6%)
- Cardiovascular disease (5%)
- Liver disease (4.8%)
At the 10-year mark, nearly 40% of cancer survivors had developed at least one chronic condition, compared to 26% in the noncancer cohort.
“AYA cancer survivors had a twofold increased risk of being diagnosed with any chronic medical condition,” said UC Davis Comprehensive Cancer Center epidemiologist Theresa Keegan, the principal investigator of the Valuing Opinions and Insight from Cancer Experience (VOICE) study. “This risk was even higher for survivors of hematologic cancers and those diagnosed with distant stage disease.”
The study also revealed that survivors were 2.3 times more likely to develop two or more chronic conditions. Elevated risks were consistent across sociodemographic groups, including race, ethnicity and insurance status.
“These findings highlight the importance of long-term surveillance and lifestyle interventions to mitigate risk,” said Keegan. “We need to ensure that survivorship care plans include strategies for early detection and management of chronic diseases to reduce premature mortality.”
The VOICE study builds on earlier work and fills critical gaps in understanding how cancer impacts long-term health outcomes in young people. It also emphasizes the need for tailored survivorship care that considers cancer type, stage at diagnosis and sociodemographic factors.
The study analyzed data from 14,917 patients from Kaiser Permanente Northern California and Kaiser Permanente Southern California aged 15 to 39. All had survived at least two years after being diagnosed with one of 11 common cancers between 2006 and 2020. These survivors were compared to a cohort of 149,164 individuals without cancer, matched by age, sex, calendar year and Kaiser Permanente location.
As cancer survival rates improve, the number of AYA survivors continues to grow. This study provides valuable insights for health care providers, policymakers and patients, reinforcing the importance of comprehensive, long-term care strategies for this vulnerable population.
Another AYA study reveals high risk of metastatic recurrence among young cancer patients
Cancer center researchers also studied AYA cancer patients to see if they were at risk of advanced cancer returning later in their lives. The study looked at seven common cancers and revealed that nearly 1 in 10 patients diagnosed with nonmetastatic disease later developed metastatic cancer.
Metastasis is when cancer cells spread from the initial or primary site to other parts of the body. It causes significantly worse survival outcomes. The findings highlight the urgent need to identify and address survivorship needs for young cancer survivors.
“As treatments improve survival, young patients with cancer face unique challenges,” said Ann Brunson, UC Davis research analyst and the study’s lead author. “Our research deepens understanding of survivorship and the impact of metastatic recurrence, using statewide data to reveal trends and guide future studies.”
The research, based on data from more than 48,000 AYAs in California, was published in JAMA Oncology in November. It is the first study of its kind to examine metastatic disease in this population.
Researchers analyzed data from the California Cancer Registry linked with statewide health care records from the California Department of Health Care Access and Information. The study group included AYAs aged 15 to 39 diagnosed with cancer between 2006 and 2018, with follow-up through the end of 2020.
The median follow-up time was 6.7 years and the median age at diagnosis was 33. Most patients were non-Hispanic white (48%) or Hispanic (32%), lived in high socioeconomic status neighborhoods (43%) and had private or military insurance (76%).
High rates of metastatic disease and recurrence
Among the 48,406 AYAs studied, 9.2% had metastatic disease at diagnosis while 9.5% developed metastatic recurrence later. AYAs with colorectal cancer (44.2%) and sarcoma (41.7%) had the highest overall proportion of metastatic disease, followed by patients with breast (23.9%), cervical (23.6%) and testicular (21.6%) cancers.
For AYAs initially diagnosed with nonmetastatic disease, the five-year cumulative incidence of metastatic recurrence was highest for those with:
- Sarcoma (24.5%)
- Colorectal cancer (21.8%)
- Cervical cancer (16.3%)
- Breast cancer (14.7%)
Cervical cancer had particularly high recurrence rates across all stages, with stage 3 patients experiencing a cumulative incidence of 41.7%.
To make sure their method for detecting metastatic recurrence was accurate, the researchers compared their findings to Kaiser Permanente Northern California and found an overall rate of 96.9% when they accounted for patients who were never completely disease-free.
“These findings highlight the significant burden of metastatic recurrence among adolescents and young adults and the need for tailored survivorship care,” said Keegan, the study’s senior author. “Understanding these patterns helps us identify inequities and evaluate how well our efforts are working to prevent, detect and treat both early and metastatic disease.”
