The adolescence of young adult oncology.
TL;DR: The field must strengthen its research in clinical trials and comparative outcomes, and must articulate the key competencies that distinguish a practitioner of young adult oncology (both to define clinical programs and educational curricula).
About: This article is published in Seminars in Oncology.The article was published on 2009-10-01. It has received 37 citations till now. The article focuses on the topics: Oncofertility & Population.
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TL;DR: The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population and for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors.
Abstract: The number of cancer survivors continues to increase because of both advances in early detection and treatment and the aging and growth of the population. For the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborate to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results cancer registries. In addition, current treatment patterns for the most prevalent cancer types are presented based on information in the National Cancer Data Base and treatment-related side effects are briefly described. More than 15.5 million Americans with a history of cancer were alive on January 1, 2016, and this number is projected to reach more than 20 million by January 1, 2026. The 3 most prevalent cancers are prostate (3,306,760), colon and rectum (724,690), and melanoma (614,460) among males and breast (3,560,570), uterine corpus (757,190), and colon and rectum (727,350) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost one-half (47%) are aged 70 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by primary care providers. Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care. CA Cancer J Clin 2016;66:271-289. © 2016 American Cancer Society.
5,516 citations
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...Although there has been less dramatic improvement in survival for adolescents, the current 5-year relative survival rate (84%) is similar to that for children.(10,44) However, survival rates vary considerably by cancer type....
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TL;DR: The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment, and current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER‐Medicare linked databases.
Abstract: The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER-Medicare linked databases; treatment-related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one-third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship.
2,383 citations
TL;DR: A particular need for psychological support has been identified for AYAs with cancer, even after active therapy has been completed and especially in the context of palliative care, and it is anticipated that clinical trial accrual will increase substantially, providing further gains in survival.
Abstract: Importance Although cancer remains the most common cause of disease-related death in adolescents and young adults (AYAs) in high-income countries, their overall survival rates continue to increase and now exceed 80% at 5 years in several high-income countries. This has been accomplished through progressive improvements in active treatment and supportive care, although accrual rates to therapeutic clinical trials remain disappointing. Recognition of the unique distribution of diseases in the AYA population with cancer and further understanding of the distinctive biology of cancers in AYAs will lead to continuing gains in clinical outcomes. Observations Many of the challenges faced by AYAs with a diagnosis of malignant disease are shared by others with chronic medical conditions and even their healthy peers, such as a sense of invulnerability that may contribute to delays in diagnosis. A particular need for psychological support has been identified for AYAs with cancer, even after active therapy has been completed and especially in the context of palliative care. Notable needs also include fertility preservation and navigation through the multiple transitions in the cancer journey. Additionally, there is a “cost of cure.” This is not only in the form of short-term, treatment-related morbidity and mortality but also in the burden of “late effects,” including second cancers, that compromise quality of life and limit life expectancy. Establishing clinical programs devoted to AYAs with cancer, with complementary educational initiatives, will strengthen the advances made. It is anticipated that clinical trial accrual will increase substantially, providing further gains in survival. Likewise, addressing the challenges of survivorship, including secondary prevention of long-term morbidity and mortality, will lead to additional improvements in clinical outcomes. Conclusions and Relevance Transferring this knowledge to the care of an estimated 1 million incident cases of cancer in AYAs worldwide, most of whom do not live in high-income countries, remains a considerable challenge.
309 citations
University of Nebraska–Lincoln1, Northwestern University2, City of Hope National Medical Center3, Vanderbilt University4, Ohio State University5, Brigham and Women's Hospital6, University of California, San Francisco7, Washington University in St. Louis8, Harvard University9, Fred Hutchinson Cancer Research Center10, Roswell Park Cancer Institute11, Stanford University12, Memorial Sloan Kettering Cancer Center13, Johns Hopkins University14, University Of Tennessee System15, University of South Florida16, University of Utah17, University of Texas MD Anderson Cancer Center18, Fox Chase Cancer Center19, Duke University20, University of Alabama at Birmingham21, University of Michigan22
TL;DR: The recommendations for age-appropriate care outlined in these NCCN Guidelines include psychosocial assessment, a discussion of infertility risks associated with treatment and options for fertility preservation, genetic and familial risk assessment for all patients after diagnosis and palliative care and end-of-life considerations for patients for whom curative therapy fails.
Abstract: Cancer is the leading cause of death among the adolescent and young adult (AYA) population, excluding homicide, suicide, or unintentional injury. AYA patients should be managed by a multidisciplinary team of health care professionals who are well-versed in the specific developmental issues relevant to this patient population. The recommendations for age-appropriate care outlined in these NCCN Guidelines include psychosocial assessment, a discussion of infertility risks associated with treatment and options for fertility preservation, genetic and familial risk assessment for all patients after diagnosis, screening and monitoring of late effects in AYA cancer survivors after successful completion of therapy, and palliative care and end-of-life considerations for patients for whom curative therapy fails.
189 citations
University of Nebraska Medical Center1, University of Tennessee Health Science Center2, Roswell Park Cancer Institute3, University of Colorado Boulder4, Vanderbilt University5, University of Michigan6, Northwestern University7, City of Hope National Medical Center8, Brigham and Women's Hospital9, University of California, San Francisco10, Johns Hopkins University11, Washington University in St. Louis12, Harvard University13, Stanford University14, University of Texas MD Anderson Cancer Center15, Case Western Reserve University16, University of California, San Diego17, Duke University18, University of Wisconsin-Madison19, University of South Florida20, Mayo Clinic21, Seattle Cancer Care Alliance22, Yale Cancer Center23, University of Utah24, Fox Chase Cancer Center25, University of Alabama at Birmingham26, Ohio State University27
TL;DR: This selection from the NCCN Guidelines for Adolescent and Young Adult (AYA) Oncology focuses on treatment and management considerations for AYA patients with cancer.
Abstract: This selection from the NCCN Guidelines for Adolescent and Young Adult (AYA) Oncology focuses on treatment and management considerations for AYA patients with cancer. Compared with older adults with cancer, AYA patients have unique needs regarding treatment, fertility counseling, psychosocial and behavioral issues, and supportive care services. The complete version of the NCCN Guidelines for AYA Oncology addresses additional aspects of caring for AYA patients, including risk factors, screening, diagnosis, and survivorship.
189 citations
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TL;DR: Evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations that exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
Abstract: Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented. Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role exploration during the late teens and twenties.
11,669 citations
01 Jan 2000
TL;DR: In this paper, emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25, and evidence is provided to support the idea that emerging adults are a distinct period demographically, subjectively, and in terms of identity explorations.
Abstract: Emerging adulthood is proposed as a new conception of development for the period from the late teens through the twenties, with a focus on ages 18-25. A theoretical background is presented, Then evidence is provided to support the idea that emerging adulthood is a distinct period demographically, subjectively, and in terms of identity explorations. How emerging adulthood differs from adolescence and young adulthood is explained. Finally, a cultural context for the idea of emerging adulthood is outlined, and it is specified that emerging adulthood exists only in cultures that allow young people a prolonged period of independent role. exploration during the late teens and twenties.
10,040 citations
TL;DR: Fertility preservation is often possible in people undergoing treatment for cancer and should be considered as early as possible during treatment planning, to preserve the full range of options.
Abstract: Purpose To develop guidance to practicing oncologists about available fertility preservation methods and related issues in people treated for cancer. Methods An expert panel and a writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature from 1987 to 2005 was performed, and included a search of online databases and consultation with content experts. Results The literature review found many cohort studies, case series, and case reports, but relatively few randomized or definitive trials examining the success and impact of fertility preservation methods in people with cancer. Fertility preservation methods are used infrequently in people with cancer. Recommendations As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists. Clinician judgment should be employed in the timing of raising this issue, but discussion at the earliest possible opportunity is encouraged. Sperm and embryo cryopreservation are considered standard practice and are widely available; other available fertility preservation methods should be considered investigational and be performed in centers with the necessary expertise.
1,784 citations
1,158 citations
TL;DR: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival.
Abstract: Background: As more and more cancers occur in elderly people, oncologists are increasingly confronted with the necessity of integrating geriatric parameters in the treatment of their patients. Methods: The International Society of Geriatric Oncology (SIOG) created a task force to review the evidence on the use of a comprehensive geriatric assessment (CGA) in cancer patients. A systematic review of the evidence was conducted. Results: Several biological and clinical correlates of aging have been identified. Their relative weight and clinical usefulness is still poorly defined. There is strong evidence that a CGA detects many problems missed by a regular assessment in general geriatric and in cancer patients. There is also strong evidence that a CGA improves function and reduces hospitalization in the elderly. There is heterogeneous evidence that it improves survival and that it is cost-effective. There is corroborative evidence from a few studies conducted in cancer patients. Screening tools exist and were successfully used in settings such as the emergency room, but globally were poorly tested. The article contains recommendations for the use of CGA in research and clinical care for older cancer patients. Conclusions: A CGA, with or without screening, and with follow-up, should be used in older cancer patients, in order to detect unaddressed problems, improve their functional status, and possibly their survival. The task force cannot recommend any specific tool or approach above others at this point and general geriatric experience should be used.
962 citations