{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:05:20Z","timestamp":1789445120944,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T00:00:00Z","timestamp":1553558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001445","name":"Alex's Lemonade Stand Foundation for Childhood Cancer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001445","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000163","name":"Pediatric Oncology Group of Ontario","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000163","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Retrospective studies have shown adolescents and young adults (<jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content>) with acute lymphoblastic leukemia (<jats:styled-content style=\"fixed-case\">ALL<\/jats:styled-content>) have superior survival when treated in pediatric versus adult centers (locus of care; <jats:styled-content style=\"fixed-case\">LOC<\/jats:styled-content>). Several adult centers recently adopted pediatric protocols. Whether this has narrowed <jats:styled-content style=\"fixed-case\">LOC<\/jats:styled-content> disparities in real\u2013world settings is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">IMPACT<\/jats:styled-content> Cohort is an Ontario population\u2013based cohort that captured demographic, disease and treatment (treatment protocol, chemotherapy doses) data for all 15\u201021\u00a0year olds diagnosed with <jats:styled-content style=\"fixed-case\">ALL<\/jats:styled-content> 1992\u20102011. Cancer outcomes were determined by chart abstraction and linkage to provincial healthcare databases. Treatment protocols were classified as pediatric\u2010 or adult\u2010based. We examined predictors of outcome, including <jats:styled-content style=\"fixed-case\">LOC<\/jats:styled-content>, protocol, disease biology, and time period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 271 patients, 152 (56%) received therapy at adult centers. 5\u2010year event\u2010free survival (<jats:styled-content style=\"fixed-case\">EFS<\/jats:styled-content>\u00a0\u00b1\u00a0SE) among <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> at pediatric vs adult centers was 72%\u00a0\u00b1\u00a04% vs 56%\u00a0\u00b1\u00a04% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.03); 5\u2010year overall survival (<jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content>) was 82%\u00a0\u00b1\u00a04% vs 64%\u00a0\u00b1\u00a04% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). After adjustment, <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> remained inferior at adult centers (hazard ratio 2.5; 95% confidence interval 1.1\u20106.1; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04). In the most recent period (2006\u20102011), 39\/59 (66%) <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> treated at adult centers received pediatric protocols. These <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> had outcomes superior to the 20 <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> treated on adult protocols, but inferior to the 44 <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> treated at pediatric centers (<jats:styled-content style=\"fixed-case\">EFS<\/jats:styled-content> 72%\u00a0\u00b1\u00a05% vs 60%\u00a0\u00b1\u00a09% vs 81%\u00a0\u00b1\u00a06%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02; <jats:styled-content style=\"fixed-case\">OS<\/jats:styled-content> 77%\u00a0\u00b1\u00a07% vs 65%\u00a0\u00b1\u00a011% vs 91%\u00a0\u00b1\u00a04%; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.004). Induction deaths and treatment\u2013related mortality did not vary by <jats:styled-content style=\"fixed-case\">LOC<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Survival disparities between <jats:styled-content style=\"fixed-case\">AYA<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">ALL<\/jats:styled-content> treated in pediatric vs adult centers have persisted over time, partially attributable to incomplete adoption of pediatric protocols by adult centers. Although pediatric protocol use has improved survival, residual disparities remain, perhaps due to other differences in care between adult and pediatric centers.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.2096","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T09:27:22Z","timestamp":1553592442000},"page":"2095-2103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["The effect of adopting pediatric protocols in adolescents and young adults with acute lymphoblastic leukemia in pediatric vs adult centers: An <scp>IMPACT<\/scp> Cohort study"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-3670","authenticated-orcid":false,"given":"Sumit","family":"Gupta","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology The Hospital for Sick Children Toronto Ontario Canada"},{"name":"Faculty of Medicine University of Toronto Toronto Ontario Canada"},{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Institute for Health Policy Evaluation and Management University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Pole","sequence":"additional","affiliation":[{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Institute for Health Policy Evaluation and Management University of Toronto Toronto Ontario Canada"},{"name":"Pediatric Oncology Group of Ontario 480 University Ave Toronto Ontario Canada"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4793-4620","authenticated-orcid":false,"given":"Nancy N.","family":"Baxter","sequence":"additional","affiliation":[{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Institute for Health Policy Evaluation and Management University of Toronto Toronto Ontario Canada"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada"},{"name":"Department of General Surgery Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0320-6042","authenticated-orcid":false,"given":"Rinku","family":"Sutradhar","sequence":"additional","affiliation":[{"name":"Cancer Research Program Institute for Clinical Evaluative Sciences Toronto Ontario Canada"},{"name":"Institute for Health Policy Evaluation and Management University of Toronto Toronto Ontario Canada"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto Ontario 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