Cancer

As is increasingly being recognized, the needs of adolescents and young adults (AYA) with cancer are poorly met met by the conventional dichotomy of the pediatric and adult health care systems, resulting in delays in diagnosis, low participation rates in clinical trials, lack of age-appropriate care, concerns about social support during therapy, and long-term psychosocial and other challenges in survivorship. It is the authors' firm belief that the deliberations at the workshop and its attendant activities will be informative and useful for colleagues beyond Canada as the network of communication in AYA oncology continues to grow.

Canada is a westernized market-economy nation with a publicly funded health care and cancer control system provided in accordance with the Canada Health Act and implemented through federal, provincial, and territorial agreements. Adolescent and young adult (AYA) cancer patients receive services within existing pediatric and adult health and/or cancer control systems, which do not adequately address the needs of AYA patients in relation to age-appropriate quality of life, developmental transitions, continuity of care, and surveillance across pediatric through adult settings.

Cancer in adolescents and young adults is a global health concern with opportunities for gains in the areas of tumor biology, clinical trial accrual, screening/prevention, and survivorship. Advocacy groups can play a prominent role as agents of change.

After an overview of mortality, morbidity, and health status among long-term survivors of cancer in adolescents and young adults (AYA), 4 examples were provided that illustrate serious outcomes that can be prevented or their severity reduced through risk-based healthcare. A conceptual model for risk-based healthcare was presented and future directions in the delivery of care for AYA cancer survivors discussed.

As written, the mission statement of the CPAC/C¹⁷ Task Force on Adolescents and Young Adults does not recognize the current economic environment and its effect on achieving the stated goals. This article explains why and how “affordability” (ie, the recognition of the impact that scarcity of resources has on the decision of where to allocate resources) should be recognized in the mission statement.

Rapid changes in genome technologies are leading to comprehensive views of genetic alterations in early onset cancers, and present new opportunities for clinical translation. In the current study, issues that are more relevant to children, adolescents, and young adult patients with cancer are highlighted.

Drug development for pediatric and adolescent cancers is hampered by the small number of cases, with diseases frequently of different histology, and different toxicities, particularly in younger children, than those in adults. This article briefly reviews some examples demonstrating success, particularly where molecular pathways are the same, and challenges in this population.

Research on the topic of screening in childhood, adolescent, and young adult cancers can follow several potential streams. This includes screening of the general population to detect these cancers or for risk factors that may affect the probability of cancer later in life.

Given the pace of social change in modern society, evidence that improves prevention policies and programs must be generated on an ongoing basis. Youth Excel is a multiprovince, multisector, multilevel collaboration for strengthening such knowledge development and exchange capacity to improve youth health outcomes.

During the critical developmental transition from childhood to adulthood, older adolescents and young adults in particular have typical concerns with establishing identity, developing a positive body image and sexual identity, separating from parents, increasing involvement with peers and dating, and beginning to make decisions about careers or employment, higher education, and/or family. Accordingly, cancer-related issues such as premature confrontation with mortality, changes in physical appearance, increased dependence on parents, disruptions in social life and school/employment because of treatment, loss of reproductive capacity, and health-related concerns about the future may be particularly distressing for adolescents and young adults.

Although cancer survivor rates have improved in the past 3 decades, adolescents and young adults (AYA) ages 15 to 29 years face unique difficulties in cancer prevention, detection, diagnosis, treatment, and survivorship. With respect to AYA cancer survivorship research, the authors present a brief overview of the challenges in research, available cohorts and databases, and potential future directions.

Young patients with cancer should be counseled about their prognosis for future fertility before treatment commences. Those patients who are assessed to be at moderate or high risk of infertility as a result of their planned treatment should be considered for fertility preservation techniques.

Efforts to increase awareness and advocacy for the distinct clinical and psychosocial needs of adolescents and young adults needed to be built on commonalities among a multisectored constituency. These efforts must have expressed a single, consensual, focused message identifying a common priority for action. The scientific, medical, and advocacy communities needed to come together to define and prioritize objectives to achieve this goal.

A review of active care issues and models of care in adolescents and young adults (AYA) with cancer was undertaken and recommendations for change made. These considerations are intended to contribute to a national initiative in AYA oncology in Canada.

Adolescents and young adults with advanced or terminal cancer had distinct needs that may not have been provided in either a pediatric or adult palliative care setting. Recommendations were suggested for improvements in provision of palliative and symptom care for this age group.

Adolescent and young adults with cancer have distinctive psychosocial concerns that set them apart from younger and older patient populations. Providing quality care for this population requires the availability and accessibility of health care professionals who understand the developmental tasks associated with this life stage and are willing to be flexible in their approach to creating a health care environment that promotes a sense of normalcy.

Survivors of cancer in childhood, adolescence, or young adult life require lifelong care that focuses not only on the medical risks that arise from their cancer therapy but also on the psychosocial, educational, and vocational implications of surviving cancer. Limitations in cancer center resources (along with survivor preference) strongly suggest that this care will need to be shared between cancer centers and primary care providers in survivors' communities.

The introduction of an adolescent and young adult oncology program will deflect scarce resources. A range of feasible and important outcomes and metrics that could be measured to validate and justify this deflection is described

A workshop was convened to identify the opportunities and challenges associated with developing and implementing a nationwide strategy for the diagnosis, treatment, and follow-up of adolescents and young adults (AYA) with cancer. The Canadian healthcare and advocacy communities were well-positioned to have a major impact and assume a leadership role in AYA cancer care.