Management of Bone Cancers in Australian Adolescents and Young Adults (AYAs) — ASN Events
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Management of Bone Cancers in Australian Adolescents and Young Adults (AYAs) (#76)

Victoria White 1 , Antoinette Anazodo 2 , Helen Bibby 1 , Lisa Orme 3 , Rachel Conyers 4 , Wayne Nicholls 5 , Ross Pinkerton 5 , Rosemary Harrup 6 , Michael Osborn 7 , Marianne Phillips 8 , Toby Trahair 2 , Kate Thompson 9 , Monica Green 10 , Michael Coory 10
  1. Cancer Council Victoria, Carlton, Vic, Australia
  2. Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
  3. Peter MacCallum Cancer Institute, Melbourne
  4. Royal Children's Hospital, Melbourne, Victoria
  5. Childrens Health Queensland, Lady Cilento Children’s Hospital, Brisbane, Queensland
  6. Royal Hobart Hospital, Hobart, Tasmania
  7. Women's and Children's Hospital , Adelaide, South Australia
  8. Princess Margaret Hospital for Children, Perth, Western Australia
  9. ONTrac, Peter MacCallum Cancer Institute, Melbourne, Victoria
  10. Murdoch Children’s Research Institute , Royal Children's Hospital, Melbourne, VIC, Australia

Background:  Bone cancer accounts for 4% of adolescent and young adult (AYA) cancers but is the second highest cause of cancer death for AYAs. While outcome depends on histological subtype, tumour extent and response to chemotherapy,  treatment type plays a role.

Aims: To describe management of AYAs with bone cancers treated in Australian paediatric and adult hospitals.

Methods: In Victoria, Queensland, Western Australia and Tasmania, population-based cancer registries identified 15- to 24-year-olds diagnosed between 1/1/2007 and 31/12/2012. Hospital medical records identified eligible cases in New South Wales and South Australia. Trained data collectors extracted diagnostic and treatment information from medical records.  

Results: Of the  first 155 cases (51% Ewings sarcoma (ES); 33% osteosarcoma, 7% chondrosarcoma, 9% other) median weeks from symptom onset to health professional consultation was 8 (range 1-156) for ES and 12 (range 1-53) for other bone cancers (BC). Median weeks from first consultation to diagnosis was 2 (range 0-35) for ES and 3 (range 0-32) for BC.  72% were treated at metropolitan adult hospitals (MAH), 17% at paediatric hospitals (PH) and 11% at regional hospitals. All ES patients received chemotherapy and 63% received radiotherapy which was consistent across treatment centres. More ES patients at MAH had surgery (63%) than PH patients (30%) (p=0.05). For other BC, surgery was more common at MAH (85%) than elsewhere (67%) (p=0.08). Chemotherapy protocols varied more in MAH than PH (ES p<.05; BC p<.05). Fertility discussions were documented for 71% of BC and 78% of ES having chemotherapy. Clinical trial enrolment was more common for BC patients at PH (25%) than MAH (2%) (p<0.05). 4% of ES patients were in a clinical trial.  

Conclusion: This is the largest population-based study of BC management in AYAs in Australia. It highlights diagnosis delays, treatment variability and low trial recruitment which all may contribute to poorer survival.

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