The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review

Abstract

Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.

Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers

“…The COVID-19 pandemic had adverse impacts on healthcare utilization among survivors of AYA cancer, for whom healthcare is necessary to manage chronic conditions and prevent second neoplasms [ 9 , 10 ]. We found that survivors of AYA cancers with high financial burdens had nearly threefold increases in their odds of delaying or skipping healthcare appointments.…”

“…Survivors of adolescent and young adult cancers, who were diagnosed between the ages 15 and 39 years (AYA survivors), already had financial and insurance-related barriers to utilizing healthcare before the pandemic [ 8 ]. COVID-19-related health care challenges may cause additional barriers for AYA survivors, affecting their treatment, management of late effects, and screening for second cancers [ 9 , 10 ]. Pandemic-related delays in cancer care have been reported in 40% to 60% of surveyed AYA survivors [ 11 ].…”

The Transformation of Adolescent and Young Adult Oncological and Supportive Care in Canada: A Mixed Methods Study

“…Possibly, navigators trained in the fear of cancer recurrence [ 10 ], mental health issues in survivorship including post-traumatic stress disorder [ 11 ], as well as occupational therapists with expertise on return to work [ 12 ] need to be employed at a national level. One of the main issues is that late effects of survivors of young adult cancers are not routinely collected [ 13 ], which places an even stronger need for open discussion about the long-term risks from trained professionals and/or navigators. Organizations such as the American Society of Clinical Oncology and the National Comprehensive Cancer Network (NCCN) have established professional guidelines to address issues related to the late-treatments effects for AYA diagnosed with cancer.…”

Provision and delivery of survivorship care for adult patients with haematological malignancies: A scoping review protocol

“…Because of this, in the UK, their treatment and ongoing care falls under specific remits and specialised services until they reach the age of 25 [ 45 ]. The TYA population have also been widely investigated in relation to their experiences of, and issues surrounding, SC and long-term follow-up [ 46 – 48 ]. Therefore, TYA patients have been excluded from the current review to focus on the adult and elderly population.…”