Young Adult Oncology: The Patients and Their Survival Challenges

Bleyer, Archie

doi:10.3322/canjclin.57.4.242

Cited by 277 publications

(236 citation statements)

References 46 publications

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“…6,11,12 In all, 101 (60%) patients were o15 years at the time of allo-HCT and 67 (40%) were 15-30 years of age (AYA). The median age at the time of allo-HCT for those o15 years of age was 8.1 (range, 0.5-14.99 years) as compared with 22.6 (range, 15.0-29.7 years) for the AYA.…”

Section: Study Design and Patient Characteristicsmentioning

confidence: 99%

“…3,4 Although overall survival appears to be similar between these two age groups (children o15 years of age vs AYAs), there are stark differences in chemotherapy-related mortality, with AYA patients having significantly higher rates of treatment-related deaths most often from infection. 3,4 The reasons why AYA patients may have significantly worse outcomes compared with younger children include: age-related differences in the underlying cancer biology; 5 access to medical care; 6 compliance with treatment, 7 participation in clinical trials 8 and/or not receiving care at centers with AYA experience. 7,9 We recently investigated survival differences between AYA patients and younger-aged children (o13 years of age) with B-cell ALL who received allogeneic hematopoietic cell transplantation (allo-HCT) at our institution and found significantly inferior survival in the AYA group.…”

Section: Introductionmentioning

confidence: 99%

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Similar outcomes between adolescent/young adults and children with AML following allogeneic hematopoietic cell transplantation

Burke

Gossai

Cao

et al. 2013

Bone Marrow Transplant

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We recently reported that adolescents and young adults (AYAs) with B-cell ALL receiving allogeneic hematopoietic cell transplantation (allo-HCT) have inferior survival compared with children, primarily because of greater TRM. We therefore hypothesized that in the setting of allo-HCT for AML, similar inferior outcomes would be observed in AYA patients as compared with children. We reviewed outcomes of 168 consecutive patients (ages 0-30 years) with AML undergoing allo-HCT at our institution. Of these, 60% (n ¼ 101) were o15 years of age and 40% (n ¼ 67) were AYAs (15-30 years of age). We identified no significant differences in 5-year overall survival (48% vs 50%, P ¼ 0.89), disease-free (47% vs 47%, P ¼ 0.89), relapse (24% vs 33%, P ¼ 0.30) or TRM (27% vs 16%, P ¼ 0.10) between the two groups. However, AYA patients had a greater incidence of grade II-IV acute (48% vs 31%, P ¼ 0.01) and chronic GVHD (22% vs 7%, Po0.01). Based on this analysis we identified no differences in survival, relapse or TRM between AYAs and children with AML receiving allo-HCT. INTRODUCTIONGradual improvements in the survival of patients with newly diagnosed AML have been achieved through treatment intensification; 1,2 however, differences in outcomes continue to exist between adolescents and young adults (AYAs) and younger-aged children. 3,4 Although overall survival appears to be similar between these two age groups (children o15 years of age vs AYAs), there are stark differences in chemotherapy-related mortality, with AYA patients having significantly higher rates of treatment-related deaths most often from infection. 3,4 The reasons why AYA patients may have significantly worse outcomes compared with younger children include: age-related differences in the underlying cancer biology; 5 access to medical care; 6 compliance with treatment, 7 participation in clinical trials 8 and/or not receiving care at centers with AYA experience. 7,9 We recently investigated survival differences between AYA patients and younger-aged children (o13 years of age) with B-cell ALL who received allogeneic hematopoietic cell transplantation (allo-HCT) at our institution and found significantly inferior survival in the AYA group. 10 These findings were primarily because of greater TRM in AYA patients. Based on these results and the higher mortality recently reported in chemotherapy-treated AYA AML patients, 3,4 we hypothesized that AML AYA patients undergoing allo-HCT would have inferior outcomes as compared with younger patients.

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Section: Study Design and Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Similar outcomes between adolescent/young adults and children with AML following allogeneic hematopoietic cell transplantation

Burke

Gossai

Cao

et al. 2013

Bone Marrow Transplant

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“…UU. se comprueba un notable incremento de la incidencia del cáncer con la edad, iniciada a los 30 años, llegando a alcanzar la máxima incidencia en pacientes mayores de 80 años (13,14). Los ancianos están rápidamente llegando a constituir el grupo más importante de la práctica oncológica médica.…”

Section: Aspectos Generales Del Cáncer En El Ancianounclassified

Prevalencia y tratamiento de la patología oncológica en el anciano: El reto que se avecina

Portilla¹,

Lecea²,

Cendoya³

et al. 2008

Rev. esp. enferm. dig.

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RESUMENLa esperanza media de vida en España se ha más que duplicado a lo largo del siglo XX, llegando en la actualidad a 75 años en el varón y 83 años en la mujer. Las predicciones de la evolución y crecimiento poblacional a nivel mundial y nacional auguran un shock demográfico cuando en España el número de mayores de 65 años alcance el 33,5% de la población en el 2050.Es conocido que el cáncer está intrínseca y directamente relacionado con la edad, siendo una patología de personas mayores, ya que al menos el 60% de ellos aparecen en mayores de 65 años. Los ancianos constituyen el grupo más importante de la práctica oncológica médica. Las predicciones de envejecimiento de la población española, permiten intuir que el cáncer en el anciano y su tratamiento deba ser considerado un problema sanitario de primer orden.El cáncer ya no es sinónimo de muerte para la mayoría de los pacientes. Globalmente el 60% se curan o cronifican. Esta mejora pronóstico tiene un precio tanto en las expectativas de tratamiento como de posterior seguimiento y mantenimiento de las secuelas que pueden generarse.El mayor y mejor conocimiento y comprensión del proceso de envejecimiento, permitirá identificar y seleccionar aquellos pacientes mayores que pueden beneficiarse de medidas de prevención y tratamiento, y lo más importante permitirá identificar aquellos pacientes que no son candidatos de tratamientos con intención curativa por tratarse de población frágil.Los adelantos en el campo de la cirugía, especialmente en la cirugía mínimamente invasiva y su aplicación al campo de la cirugía oncológica, permiten prever que un mayor número de pacientes ancianos podrán beneficiarse de un tratamiento con intención curativa. La edad no prevendrá de tratamientos apropiados en individuos ancianos con cáncer, especialmente aquellos en los que tengan una adecuada expectativa de vida y reserva funcional. Combatir esta discriminación sanitaria constituye una de las principales prioridades en la estrategia para el mantenimiento de la salud del anciano. ABSTRACTLife expectancy in Spain has more than duplicated during the last 20 th Century, and is currently 75 years for men and 83 years for women. Predictions on the evolution of the National and global population anticipate a demographic shock in Spain when individuals older than 65 years eventually make up more than 33.5% of the Spanish population by year 2050.It is known that cancer is directly related with age, and that it is a disease of older people -at least 60% of all cancers are diagnosed in patients older than 65 years. The older people group is the most important group of patients in oncologic practice today. Predictions on the aging of the Spanish population show that cancer in the aging patient and its treatment must be considered a first-line health problem. The diagnosis of cancer is not associated with death in the majority of patients. Sixty percent of cancers are globally cured or chronified. This advanced prognosis has its toll not only in the expectancy of treatment but also in subseque...

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“…Adolescents and young adults may also be particularly reliant on their peer groups. Changes in self-image associated with cancer therapy may therefore contribute to feelings of isolation and social removal, making it more difficult for patients to address those issues with others 12 . Young women may be even more affected than young men, given that cryopreservation of oocytes (compared with spermatozoa) requires more invasive techniques 13 .…”

Section: 13mentioning

confidence: 99%

“…Psychosocial Services Quantitative improvements in cancer prognosis have also accentuated the importance of qualitative survival and of diminishing the psychosocial impact of a new cancer diagnosis 11,12 . Young women and men may feel psychologically distressed and overwhelmed by information and by fast-occurring changes in their health.…”

Section: 13mentioning

confidence: 99%

Oncofertility in Canada: An Overview of Canadian Practice and Suggested Action Plan

Ronn

Holzer

2013

Current Oncology

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Background: Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. Methods: Here, we describe the services currently available in Canada and the challenges associated with their utilization. Finally, we outline strategies to help maximize and facilitate fertility preservation in the young cancer patient. Results: Despite an existing infrastructure to the oncofertility system in Canada, the ability of that system’s components to function together and to coordinate patient care is a challenge. Areas of weakness include poor access and referral to fertility services, a lack of readily available education for patients and health care providers, and inconsistent interdisciplinary coordination in patient care. Conclusions: The implementation of a framework for multidisciplinary resource allocation, education, patient referral, and established lines of communication may facilitate a functional oncofertility system in Canada.

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Young Adult Oncology: The Patients and Their Survival Challenges

Cited by 277 publications

References 46 publications

Similar outcomes between adolescent/young adults and children with AML following allogeneic hematopoietic cell transplantation

Similar outcomes between adolescent/young adults and children with AML following allogeneic hematopoietic cell transplantation

Prevalencia y tratamiento de la patología oncológica en el anciano: El reto que se avecina

Oncofertility in Canada: An Overview of Canadian Practice and Suggested Action Plan

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