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Forum: Cancer in adolescents and young adults
Archie Bleyer
Abstract
That cancer may have a different biology in young adults and older adolescents than in younger or older persons is becoming more evident. This review summarises recent reports that contain such data in five of the common types of cancer in adolescents and young adults: sarcomas, acute lymphoblastic and myelogenous leukaemia, colorectal and breast cancer. The findings, along with those in other cancers and with the unique array of cancer types in adolescents and young adults and their age-dependent incidence patterns, suggest that cancer biology in the age group may be different more often than not. Regardless, there is now sufficient evidence to merit methodical research of the underlying biology of cancer in young adults and older adolescents, with the implication that cancer therapy in the age group cannot be optimised until differences and similarities are established. Initiatives underway to address this need include implementation of the US National Cancer Institute Adolescent and Young Adult Oncology Program Review Group by the LiveStrong Young Adult Alliance, the Aflac/CureSearch Adolescent and Young Adult Cancer Research Program, the Children’s Oncology Group Adolescent and Young Adult Committee and a combined effort of the US National Adult Cancer Cooperative Groups.
Susan Hanson, Liam Hunt and Barbara Merz
Abstract
There is mounting national and international evidence to support targeted improvements in cancer care services for adolescents and for young adults; an age group defined in Australia as those between 15 and 25 years. Both paediatric and adult oncology and haematology services currently provide cancer care for adolescents and young adults. There are many unmet needs under the current service delivery paradigm - both physical and psychosocial. Improving cancer outcomes for young people is clearly multidimensional and must be achieved over time. Cancer Australia brought together a diverse set of stakeholders to form the Adolescents and Young Adults Cancers National Reference Group. With support from CanTeen, a peer support organisation for adolescents and young adults with cancer, the reference group developed a service delivery framework which aims to reduce the impact of cancer on young Australians. Adolescents and young adults are receiving treatment, across many centres throughout Australia, and will benefit from: better coordination of existing services; and, promotion of access to these coordinated services. At present, a broader consultation on the framework for adolescent and young adult cancer care has commenced with state and territory health jurisdictions.
Robin P Corbett
Abstract
A small number of adolescents and young adults are diagnosed with solid tumours that typically occur in childhood – the most common are neuroblastoma, Wilms’ tumour and rhabdomyosarcoma. In general, these cancers are often more locally advanced or metastatic when they occur in adolescents and young adults compared with childhood presentations. Multidisciplinary and multimodality care is indicated, usually including surgery, chemotherapy and radiotherapy. Although these tumours often respond to treatment, the overall survival of adolescents and young adults is inferior to that of children. Retrospective analyses of subsets of older patients with Wilms’ tumour and rhabdomyosarcoma suggest that prognosis is improved when treatment is delivered according to paediatric guidelines. However, tumour biology must, at least in part, account for the differences in outcome observed between adolescents and young adults and children. A paradigm of cooperative care between adult and paediatric oncologists is encouraged – entry on to age-appropriate clinical trials should be standard of care. Taking these considerations into account, a national Adolescents and Young Adults Cancer Service has been established in New Zealand, premised upon multidisciplinary cooperative care for adolescents and young adults with cancer and their families.
Michele Su-Ming Yeo and Susan M Sawyer
Abstract
Adolescents and young adults with cancer have unique medical and psychosocial needs. In addition to efforts aimed at improving survival, there is acknowledgement of the need to understand how social and emotional outcomes can also be improved for this group of young people. Psychosocial assessment firstly provides an important means of understanding how cancer, its treatment, late effects and its management affect the developmental concerns of young people. Secondly, psychosocial screening also helps identify preventable behaviours that add to the risk burden of young people with cancer and helps guide counselling and anticipatory guidance. Finally, the assessment helps effect a long-term management plan, taking into account complex socio-environmental factors that can affect adherence and transition to adult health care settings.
Susan Palmer
Abstract
As recognition continues to grow in relation to the specific needs of the AYA oncology population, discussion inevitably turns to potential systemic changes that can provide generalised improvements to this population group. While a necessary process, it should not deter discussions relating to how care can be improved ‘right now’ on an individual practitioner level. There is much that can be learnt from our colleagues working in adolescent medicine that, when applied in an oncology setting, can serve to improve the developmentally appropriate care provided to AYA oncology patients and directly improve outcomes for this vulnerable age group.
David Thomas, Sally Whyte, Peter Choong
Abstract
Sarcomas represent a small, diverse and high impact group of cancers that disproportionately affect the young. There is good data to link outcomes to clinical research participation for many cancers, including sarcomas. Historically neglected because of the rarity of these disorders, Australian clinicians first began to self-organise about a decade ago, to develop the Australian Sarcoma Group, a society designed to increase the focus on sarcomas in Australia. In December 2007, with Cancer Australia funding, the Australian Sarcoma Group took the next step towards establishing an effective clinical research co-operative group, by forming the Australian Sarcoma Study Group. This group has been in existence for only 12 months, but already has a keen multidisciplinary group and a portfolio of research.
Rob George and Finella Craig
Abstract
Adolescents occupy a world between paediatric and adult palliative practice. Here we consider what is particular to adolescence, that physical, cognitive and emotional change during which the adult identity is formed. Some patients will have been progressing through normal development before the onset of disease while others carry their diagnosis from childhood. For all, life-threatening malignancy challenges adolescent development and, equally, development influences how adolescents, families and professionals experience and manage their disease journeys. In writing, we are acutely aware of the differences between adult and paediatric practice, as well as the common ground. Adult clinicians focus on autonomy. Paediatricians are more aware of the adolescent as a child without the experience of independence. This may be crystallised as follows: we want young people to make decisions about their treatments and to be fully informed that they are dying; yet they still need parental permission to go to parties and to stay out late - and they quite possibly consider it completely reasonable for their mothers to choose and buy their underwear. The trick is to recognise and support the child with little experience of life as an adult, while at the same time facilitating their transition to an adulthood that may never be achieved.
This page was last updated on : Wednesday, 24 June 2009
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