A new study of adolescents and young adults (AYAs) with seven common cancers reveals that nearly one in ten patients diagnosed with nonmetastatic disease later develop metastatic recurrence—a condition associated with significantly worse survival outcomes. Metastasis is when cancer cells spread from the original or primary site to other parts of the body. It comes with significantly worse survival outcomes.
Scientists at the UC Davis Comprehensive Cancer Center led the research. The findings highlight the urgent need to identify and address survivorship needs for young cancer survivors.
“As treatments improve survival, young cancer patients face unique challenges,” said Ann Brunson, research analyst at UC Davis and lead author of the study. “Our research deepens our understanding of survival and the impact of metastatic recurrence by 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 the JAMA Oncology on November 26. It is the first study of its kind to examine metastatic disease in this population.
Researchers analyzed data from the California Cancer Registry linked to statewide health care records by the California Department of Health Care Access and Information (HCAI). The study cohort included HCWs aged 15–39 years diagnosed with cancer between 2006 and 2018, with follow-up until the end of 2020. Metastatic recurrence was defined by specific HCAI diagnosis codes or cause of cancer death.
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% experienced metastatic recurrence later. AWAs with colon cancer (44.2%) and sarcoma (41.7%) had the highest overall rate of metastatic disease, followed by patients with breast (23.9%), cervical (23.6%), and testicular (21.6%) cancer.
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 having a cumulative incidence of 41.7%.
The study also found that relapse rates varied over time. Cervical cancer recurrence increased from 12.7% in 2006-2009 to 20.4% in 2015-2018, while colon cancer and melanoma showed a decrease. Specifically, stage 1 cervical cancer showed the sharpest increase, while stage 3 melanoma had a significant decrease in recurrence.
Survival after metastatic recurrence was worse than survival for those initially diagnosed with metastatic disease, except for testicular and thyroid cancer. Breast cancer patients with metastatic recurrence had almost three times the risk of death (HR=2.87), while patients with cervical (HR=2.10), melanoma (HR=1.61), sarcoma (HR=1.57), and colorectal cancer (HR=1.53) also faced significantly higher risks of death.
To make sure their method of detecting metastatic recurrence was accurate, the researchers compared their findings with Kaiser Permanente Northern California and found an overall agreement rate of 96.9% when counting 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 personalized survivorship care,” said Theresa Keegan, lead author of the study. “Understanding these patterns helps us identify disparities and assess how well our efforts to prevent, detect and treat both early and metastatic disease are working.”
