Canadian adolescents and young adults with cancer: opportunity to improve coordination and level of care

Principles and Recommendations for the Provision of Healthcare in Canada to Adolescent and Young Adult–Aged Cancer Patients and Survivors

“…Many of their care priorities and needs are unique and not adequately met within either care model. 3,12 Furthermore, communication and collaboration between pediatric and adult healthcare providers is at best well-intentioned but far too limited, and at worst strained by competing interests, priorities, and resources. As a result, the care provided to AYA patients is often fragmented, poorly coordinated, and characterized by delays in diagnosis, poor accrual to appropriate clinical trials, and insufficient access to age-appropriate supportive care and psychosocial resources.…”

“…AYA patients comprise a complex and diverse group with varying levels of developmental maturity, and consequentially unique and largely unmet clinical and psychosocial needs 2 While cancer is relatively uncommon among AYAs compared to older adults, its personal, societal, and socioeconomic impact is disproportionately greater 3,4 Cancer in AYAs includes a broad spectrum of different tumor types from those occurring most frequently in children (i.e., non-epithelial) to those most frequent in adults (i.e., epithelial), requiring a correspondingly broad range of expertise for optimal management 3,5 Over the past 30 years, survival of AYA patients has changed little or not at all compared with the substantial improvements seen in children and older adult cancer patients AYAs with cancer are largely understudied compared with both younger and older patients. Lack of opportunities for participation in clinical trials, studies examining late effects of therapy, and tissue banking for translational research have all impeded progress in this population 7 The consequences of these unique features are outlined below and form the basis of this report and its recommendations, which consider both those diagnosed with cancer aged 15-29 and those aged 15-29 whom are survivors of childhood cancers.…”

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

“…Treatment for early stage HL in Quebec in 2010 comprised two to four cycles of anthracycline‐containing chemotherapy followed by involved field radiotherapy (20–36 Gy). In such cases, five‐year overall survival is expected to approach approximately 95% (2) . However, it is now well established that, in the longer term, these patients are at risk for thoracic radiotherapy treatment‐related death, in particular due to cardiovascular events and secondary malignancies 3 , 4 , 5 .…”

Increasing the Number of Clinical Trials Available to Adolescents Diagnosed With Cancer

“…Fortunately, the median survival for many cancers of adolescents is, in fact, favorable, 6 necessitating adjustment of measurable outcomes from quantity of survival to quality of survival (ie, what the cost of cure has been with respect to late effects of therapy). 7 However, 9 of the 26 most frequent types of cancer in the adolescent age group had a 5-year survival rate of ,70% (Table 1).…”