Study sheds light on risk of metastatic recurrence among young cancer patients

The findings highlight the need for tailored survivorship care

A new study of adolescents and young adults (AYAs) with 7 common cancers reveals that nearly 1 in 10 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 initial or primary site to other parts of the body.

The study, published in JAMA Oncology, is the first of its kind to examine metastatic disease in this population. It used data from the VOICE (Valuing Opinions and Insight from Cancer Experience) Study, which was co-led by Jessica Chubak, PhD, a senior investigator at Kaiser Permanente Washington Health Research Institute.

“Adolescents and young adults diagnosed with cancer have historically received less attention from researchers than those with childhood or later-life cancer,” said Chubak, who is a coauthor of the new paper. “This study helps build knowledge for an important group of cancer survivors.”

Such knowledge can help guide future research and improve care for AYA cancer survivors.

“As treatments improve survival, young patients with cancer face unique challenges,” said lead author Ann Brunson, a research analyst at UC Davis Comprehensive Cancer Center. “Our research deepens understanding of survivorship and the impact of metastatic recurrence.”

Differences across cancer types

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 more than 48,000 AYAs ages 15 to 39 diagnosed with cancer between 2006 and 2018, with follow-up through the end of 2020. Metastatic recurrence was identified by specific diagnosis codes or cancer cause of 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%).

Among the AYAs studied, 9.2% had metastatic disease at diagnosis while 9.5% developed metastatic recurrence later. The highest overall proportion of metastatic disease was among AYAs with colorectal cancer (44.2%) and sarcoma (41.7%), followed by those with breast (23.9%), cervical (23.6%), and testicular (21.6%) cancers.

For AYAs initially diagnosed with nonmetastatic disease, the 5-year cumulative incidence of metastatic recurrence was highest for those with sarcoma (24.5%), colorectal cancer (21.8%), cervical cancer (16.3%), and 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%.

The study also found that recurrence rates varied over time. For cervical cancer, the 5-year cumulative incidence of metastatic recurrence increased from 12.7% in 2006-2009 to 20.4% in 2015-2018, while colorectal cancer and melanoma saw declines. Notably, stage 1 cervical cancer showed the most pronounced increase, while stage 3 melanoma had a significant decrease in recurrence.

Survival for patients with metastatic recurrence was worse than survival for those diagnosed with metastatic disease initially, except in testicular and thyroid cancers.

“These findings highlight the significant burden of metastatic recurrence among adolescents and young adults and the need for tailored survivorship care,” said senior author Theresa Keegan, PhD, MS, a professor of medicine at UC Davis Comprehensive Cancer Center. “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.”

This story was adapted from a press release from UC Davis Health.