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The teenage years can be difficult as children try to get used to being adult. Some people escape difficulty whilst others have a really hard time. Teenagers with cancer have yet another issue to come to terms with and most health professionals working with them realise how disadvantaged they are with regard to an appropriate hospital environment and behaviour from all those with whom they come into contact. Earlier this month the Teenage Cancer Trust (a UK voluntary organisation) held its Third International Conference on Cancer and the Adolescent at The Royal College of Physicians, London. The first surprising piece of information for me was that the overall incidence of cancer has risen in 13–24 year olds in the period 1979–2000 from 15.4 to 19.8 per 100,000 – an average increase of 1.2%/year. Although cancer is still rare in this age range, it is still the leading cause of death after accidents with around 1,500 cases/year in England. Among 13 and 14 year olds, leukaemia accounts for 22% of cancers, followed by lymphoma (21%) and brain tumours (18%). Lymphoma also dominates the 20–24 year olds followed by carcinomas and germ cell tumours. Much less is known about the causes and risk factors of cancer for adolescents and young adults than for older adults. According to Professor Birch, Cancer Research UK, the likely reasons for the increases are environmental and lifestyle factors in a genetically susceptible individual. She called for a specialised system of cancer registration in these groups.

As far as treatment for cancer is concerned, whilst 75% of children are entered into clinical trials, this drops alarmingly in the teenager and young adult. Not only are these groups of patients disadvantaged but future generations are also, because the evidence-base for treatment and its effects is low. Dr Ian Gibson MP, Chair of the All Party Working Group on Cancer called on the Government to make further provision for teenagers with cancer, adding that there was very little statistical information available for this age group compared with for children and adults.

Aside from the public health issues, there are also many human ones. Patients in this age range told their stories which included the isolation felt by not having their peers around them and being cared for in either a children's unit or one where patients were all older adults. When asked what they thought about when confronted with a diagnosis of cancer, responses included effects of cancer and its treatment on fertility, missing out on college and university, missing socialising and forming relationships and the whole disruptive business of having to be dependent on parents and the hospital when the whole emphasis for their age is to be independent. Family equilibrium is certainly a casualty of all of this.

The NHS's National Institute for Clinical Excellence (NICE) is however now looking into this problem through the establishment of the Guidelines Development Group for Children and Adolescent Cancer.

On a separate note, NICE has also now published the long awaited guidance manual, Improving Supportive and Palliative Care for Adults with Cancer (March 2004). The manual which can be downloaded from their website defines service models likely to ensure that adult cancer patients and their carers receive support and help to cope with cancer and its treatment at all stages. The views of a wide range of professionals and users of services were canvassed at each step of this manual's development which was followed by draft guidance made available for consultation before the final version was produced. It is inevitably a weighty tome but worth the reading. As always, the Editor welcomes comments on these topics from other parts of the world – by mail or email. I look forward to hearing from you.

Also see: Cancer Research UK http://www.cancerresearch.co.uk NHS national Institute of Clinical Excellence http://www.nice.org.uk UK Teenage Cancer Trust http://www.teencancer.org