Purpose: Adolescent and young adult (AYA) oncology patients experience unique biological, behavioral, and socioeconomic challenges, for which provision of care must be tailored. AYAs with central nervous system (CNS) tumors and sarcomas represent a vulnerable population with worse outcomes and potential for serious sequelae from intense multimodal therapy. Comorbidity burden impacts treatment tolerance, adherence, and efficacy, yet has been understudied among these high-risk AYA patients. Methods: Utilizing a validated AYA oncology comorbidity index, we (1) measured comorbid conditions present at diagnosis in AYA-aged patients with CNS tumors and sarcomas and (2) compared baseline comorbidity burden across ascending AYA age groups (15-19, 20-29, and 30-39 years) and with pediatric patients (10-14 years). Results: The cohort included 131 AYAs and 50 pediatric patients. Mean comorbidity score significantly differed between pediatric (0.8) and AYA (1.7) patients, and across ascending age subgroups (0.8 [10-14] < 1.2 [15-19] < 1.7 [20-29] < 2.5 [30-39]). AYAs were significantly more likely than pediatric patients to have ≥2 or ≥3 comorbidities (47% vs. 18%, 24% vs. 6%), with increasing prevalence across ascending age subgroups. Frequency of overweight/obese status, smoking/substance use, obstetric/gynecologic conditions, and cardiovascular comorbidities increased with age. In multivariate analyses adjusting for sex, tumor type, and race, age remained a significant predictor of comorbidity score. Conclusions: AYAs with CNS tumors or sarcomas have a high burden of baseline comorbidities, which increase with age at diagnosis, conferring susceptibility to treatment-related toxicity and mortality. Improving the prognosis for AYAs requires appropriate identification of pre-existing comorbidities and tailoring therapeutic and supportive care accordingly.
Keywords: adolescent and young adult (AYA); age; central nervous system (CNS) tumors; comorbidities; sarcomas.