Guideline-concordant treatment among adolescents and young adults with acute lymphoblastic leukemia
Bibliographic record
Abstract
BACKGROUND: Individuals diagnosed with acute lymphoblastic leukemia (ALL) between adolescents and young adults aged 15-39 years face poor survival and unique challenges. We evaluated facility-level factors and guideline-concordant care among adolescents and young adults with ALL at National Cancer Institute Community Oncology Research Program (NCORP) practices. METHODS: We assembled a retrospective cohort of adolescents and young adults aged 15-39 years with ALL treated at participating NCORPs between 2012 and 2016. NCORPs abstracted patient data and completed facility-level questionnaires for each clinical facility (study-defined criteria). The central review committee adjudicated whether treatment was concordant with adolescent and young adult-specific National Comprehensive Cancer Network ALL guidelines (ie, pediatric-inspired therapy or clinical trial). Guideline-concordant care was described by age, facility model (adult/internal medicine, pediatric, mixed [pediatric services within a general hospital]), and average annual adolescents and young adult ALL volume. Generalized linear mixed effects models estimated the odds of guideline-concordant care. RESULTS: Adolescents and young adults receiving guideline-concordant care were younger (n = 196; median = 19.5 years) than those who did not (n = 31; median = 32.1 years). Guideline-concordant care was observed in many adolescents and young adults aged 22-39 years (68.8%), and nearly universal in those aged 15-21 years. In multivariable analyses, adolescents and young adults at adult/internal medicine clinical facilities had lower odds of guideline-concordant care (odds ratio = 0.02, 95% confidence interval = 0.0 to 0.18); there was no statistically significant association between annual adolescent and young ALL volume and receiving guideline-concordant care. Guideline-concordant care was observed more often in adult/internal medicine and/or mixed clinical facilities with communication between adult or pediatric counterparts, adolescents and young adult ALL clinical pathways, and/or adolescent and young adult-specific meetings. CONCLUSION: Guideline-concordant care among adolescents and young adults with ALL (specifically pediatric-inspired therapy) at NCORPs is associated with facility model (adult/internal medicine) but not adolescent and young adult ALL volume. Strategies to improve guideline-concordant care could include facilitating communication and clinical pathways at adult/internal medicine clinical facilities treating adolescent and young adult ALL.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".