Abstract 786: Geography and adolescent and young adult cancer stage and survival

Background. Survival improvement in adolescents and young adults (AYA) diagnosed with cancer has lagged behind other age groups. Few studies have focused on geographic factors and outcomes in AYA. Our objective was to evaluate evidence for geographic disparities in cancer diagnosis stage and overall survival in AYAs. We also examined whether stage mediated survival associations. Methods. National Cancer Database data on AYA 15-39 years diagnosed from 2010-2014 were obtained. Rural/metro residence at diagnosis was defined using Rural Urban Continuum Codes. Distance between the case9s residence and the reporting hospital was classified as short ( 12.5 and 50 miles). Logistic and Cox proportional hazards regression models were used for analyses. Results. The stage and survival analyses included 146,418 and 178,688 AYA. The odds of a late vs. early stage diagnosis (stages 3 and 4 vs. 1 and 2) were 1.22 (95% CI 1.10 to1.35) times higher for AYA living in rural vs. metro counties and 1.23 (1.19 to1.28) times higher for AYA living at long vs. short distances. The hazard of death was 1.18 (1.04 to 1.34) and 1.37 (1.31 to 1.43) times higher for those living in rural vs. metro counties and for long vs. short distances. Stage mediated 41% and 27% of the associations between survival and rural/metro residence and residential distance. Conclusions. Rural residence and living long distances from the reporting hospital were associated with later-stage diagnoses and lower survival in AYA cancer patients. Further research is needed to understand mechanisms. Citation Format: Kimberly J. Johnson, Xiaoyan Wang, Justin Barnes, Arash Delavar. Geography and adolescent and young adult cancer stage and survival [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 786.