Impact of Adolescent and Young Adult Cancer Expertise in Oncologists on AYA Outcomes in Hodgkin Lymphoma: A Population‐Based Study in Ontario, Canada

PURPOSE: To determine whether adolescent and young adults (AYA) with Hodgkin lymphoma (HL) who are treated by oncologists with "AYA expertise" improve outcomes. METHODS: All AYA aged 15-21 years diagnosed with HL in Ontario, Canada between 1992 and 2012 were identified, and clinical data abstracted as part of the IMPACT cohort. Linked administrative data were used to identify primary oncologists, defined as "AYA experts" if at diagnosis, ≥ 15% of the oncologist's previous 2 years of chemotherapy billings were for patients aged 15-29 years. Associations between seeing an AYA expert and outcomes were analysed. RESULTS: Among 863 AYA with HL, 225 unique primary oncologists were identified. A total of 112 (13.0%) AYA had a primary oncologist with AYA expertise. Older patients [adjusted OR (aOR): 0.8 per year, 95% CI: 0.7-1.0; p = 0.04] and those seen in adult community hospitals [vs. regional cancer centre, aOR: 0.1, 95% CI: 0.02-0.4; p = 0.001] were less likely to see an AYA expert. Only 56 (6.4%) AYA received a fertility consult within 30 days of HL diagnosis; most occurred in the later study period (2006-2012). Seeing an AYA expert was associated with increased odds of fertility consultation (aOR: 2.1, 95% CI: 1.0-4.3; p = 0.04). Among the full cohort, there was no association between AYA expert care and event-free survival (EFS), overall survival (OS), or subsequent live birth. CONCLUSION: A volume-based definition of AYA expertise was associated with receipt of fertility consults, but not with EFS or OS for AYA with HL. If validated in other populations and settings, seeing a volume-defined AYA expert could serve as a quality metric in AYA cancer care.