Re-Evaluating Young Adult Cancer Survival in Light of the AIDS Epidemic

By Katy Mena-Berkley
Monday, July 1, 2019

From 1975 to 1997, five-year relative cancer survival rates among adolescents and young adults (AYAs) dropped significantly — a fact that researchers now link to HIV- and AIDS-related cancers.

“With the passage of time, it has become evident that the HIV/AIDS epidemic in the United States from the early 1980s to the late 1990s coincided with the time period when adolescents and young adults [ages 15 to 39 years] had the worst overall cancer survival,” says Lihua Liu, PhD, Associate Professor of Clinical Preventive Medicine and Spatial Sciences at Keck School of Medicine at the University of Southern California. “We know that male AYAs were particularly affected by HIV/AIDS infections, and certain cancers such as Kaposi sarcoma were associated with HIV/AIDS developments.”

Taking those factors into account, Liu and fellow researchers re-evaluated AYA cancer survival over a longer time period. This allowed them to examine overall AYA cancer survival before and after the epidemic and to filter out the impact of HIV/AIDS on the assessment during the years before effective therapies were available to treat HIV/AIDS.

“We need to pay more attention to the unique challenges that face AYA cancer survivors, including the late and long-term treatment side effects, reduced access to age-appropriate care, impaired psychosocial well-being, infertility, financial hardship, and other problems that have lifelong implications.”
— Lihua Liu, PhD, Associate Professor of Clinical Preventive Medicine and Spatial Sciences, Keck School of Medicine, University of Southern California

The Findings

The research team discovered that HIV/AIDS-related cancers were responsible for a significant portion of the cancer deaths in that age group. Once those specific cancers were removed from the statistics, the researchers found that the AYA population actually had one of the highest survival rates.

“Our analysis showed that continuous and steady progress in the overall five-year cancer survival rate was clearly observed for all age groups during the study period of 1973–2014, including the AYAs, when the impact of HIV/AIDS was removed,” says Diana Moke, MD, MS, Attending Physician and Clinical Instructor of Pediatrics at Keck School of Medicine. “Physicians should be encouraged by the positive impact of improved cancer therapies that have benefited this age group.”

Liu believes that with more AYA-focused research on prevention, early detection and improved treatment, cancer outcomes for this group will continue to improve steadily. However, she adds, it must receive the same attention and investment as pediatric and adult oncology to help clinicians properly understand the difficulties AYAs diagnosed with cancer encounter.