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Are survival and mortality rates associated with recruitment to clinical trials in teenage and young adult patients with acute lymphoblastic leukaemia? A retrospective observational analysis in England
  1. Rachael Hough1,
  2. Sabrina Sandhu2,
  3. Maria Khan2,
  4. Anthony Moran2,
  5. Richard Feltbower3,
  6. Charles Stiller2,
  7. Mike C G Stevens4,
  8. Clare Rowntree5,
  9. Ajay Vora6,
  10. Martin G McCabe7
  1. 1 University College Hospital, London, UK
  2. 2 National Cancer Registration and Analysis Service, Public Health England, London, UK
  3. 3 Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK
  4. 4 University of Bristol, Bristol, UK
  5. 5 University Hospital of Wales, Cardiff, UK
  6. 6 Sheffield Children’s Hospital, Western Bank, London, UK
  7. 7 Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
  1. Correspondence to and Dr Rachael Hough; rachael.hough{at}uclh.nhs.uk

Abstract

Objective Participation rates in clinical trials are low in teenagers and young adults (TYA) with cancer. Whilst the importance of clinical trials in informing best practice is well established, data regarding individual patient benefit are scarce. We have investigated the association between overall survival and trial recruitment in TYA patients with acute lymphoblastic leukaemia (ALL).

Design Retrospective.

Setting National (England) TYA patients treated for ALL.

Participants 511 patients aged 15–24 years diagnosed with ALL between 2004 and 2010 inclusive, of whom 239 (46.7%) participated in the UKALL2003 trial.

Outcome measures Patients were identified using National Clinical Trial (UKALL2003) and Cancer Registry (National Cancer Data Repository, English National Cancer Online Registration Environment) Databases. Relative survival rates were calculated for trial and non-trial patients and observed differences were modelled using a multiple regression approach. The numbers and percentages of deaths in those patients included in the survival analysis were determined for each 3-month period, p values were calculated using the two-tailed z-test for difference between proportions and 95% CIs for percentage deaths were derived using the binomial distribution based on the Wilson Score method.

Results Patients treated on the trial had a 17.9% better 2-year survival (85.4% vs 67.5%, p<0.001) and 8.9% better 1-year survival (90.8% vs 81.9%, p=0.004) than those not on the trial. 35 (14.6%) patients recruited to the trial died in the 2 years following diagnosis compared with 86 (32.6%) of those not recruited (p<0.001).

Conclusions TYA patients recruited to the clinical trial UKALL 2003 in England had a lower risk of mortality and a higher overall survival than contemporaneous non-trial patients. These data underline the potential for individual patient benefit in participating in a clinical trial and the importance of international efforts to increase trial participation in the TYA age group.

Trial registration number ISRCTN07355119.

  • clinical trials
  • survival
  • teenage and young adult
  • acute lymphoblastic leukaemia

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors The study was designed by RH, SS, MK, AM, RF, CS and MMC. RH, CR and AV designed, recruited and analysed data for the UKALL2003 study. The statistical analysis of this study was performed by SS, MK, AM and MMC. All authors contributed to the interpretation of data and preparation of the manuscript and approve this final version.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from this study.

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