Influence of Insurance and Marital Status on Outcomes of Adolescents and Young Adults With Acute Lymphoblastic Leukemia

Abstract Background Although outcomes for adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) are worse when treated according to adult rather than pediatric protocols, one criticism is that this may be due to the emancipation of young adults. Methods Using case listing session of Surveillance, Epidemiology, and End Results (SEER) 18 (1973-2010), we examined outcomes for AYA with ALL defined similar to Cancer and Leukemia Group B (CALGB) 10,403 criteria (age 18-30) predicated on marital and insurance status as surrogates for emancipation (limiting analysis to 2007-2010). Analyses were conducted with SEER*Stat 8.1.2, Microsoft Excel 2007, and GraphPad Prism 6. Comparisons were made by the Fisher exact test and log rank test (Mantel-Cox); all P values were 2-sided. Results Although age (24 and younger vs. 25 and older) was predictive of median overall survival (OS) (not reached vs. 33; P  = .0029) (3-year OS 66% vs. 49%), social factors were not. Three-year OS for insured versus uninsured patients was 61% versus 50%, and median OS was not reached versus 30 months ( P  = .2334). Three-year OS for single versus married patients was 62% versus 55%, with median OS not reached for both groups ( P  = .1084). Conclusion Insurance status and marriage did not influence outcomes for AYA with ALL, suggesting that intrinsic differences in disease and disease-specific therapies are more important than social issues.