Adolescent and young adult cancer survivorship: The new frontier for investigation

Abstract

Adolescent and young adult cancer survivors are at long‐term risk of early mortality. More research is needed to understand these risks and to develop effective interventions with the expectation that this group may be unique compared with other age groups.

A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults

“…Participants were randomly assigned to either the exercise intervention group or control group following baseline assessment. Participants were stratified according to gender and treatment intensity (high vs moderate; adapted from the Intensity of Treatment Rating Scale 3,48 (Supporting Information Table S2) and randomized by block randomization with a 1:1 allocation using mixed block sizes of 2 and 4. Allocation was concealed by opaque envelopes at the coordinating site.…”

“…With five-year survival for adolescents and young adults (AYA) with cancer now exceeding 80%, 1,2 a growing number of survivors are at risk of the physical and psychosocial complications of cancer and its treatment. 3,4 In particular, cardiorespiratory fitness is reduced in cancer survivors across the age spectrum. This often persists into longterm survivorship, and is associated with increased cardiovascular disease risk and late mortality.…”

Loss to follow‐up of minorities, adolescents, and young adults on clinical trials: A report from the Children's Oncology Group

“…AYA trial enrollment disparities on both pediatric and adult clinical trials have been noted in prior studies, which translates to fewer AYAs having access to innovative therapies and challenges in evaluating potential differences in therapy toxicities. 10,15,[23][24][25][26][27][28][29][30][31] Even among AYAs that do enroll on trials and have more structured follow-up guidelines, our study found that they have significantly higher loss to follow-up rates compared to their younger counterparts. The results of these analyses among clinical trial participants shed light on inequities in long-term follow-up and suggest that the loss to follow-up rate may be even higher in AYAs not enrolled on trials.…”

“…AYA trial enrollment disparities on both pediatric and adult clinical trials have been noted in prior studies, which translates to fewer AYAs having access to innovative therapies and challenges in evaluating potential differences in therapy toxicities 10,15,23–31 . Even among AYAs that do enroll on trials and have more structured follow‐up guidelines, our study found that they have significantly higher loss to follow‐up rates compared to their younger counterparts.…”

Comprehensive Assessment of Incidence, Risk Factors, and Mechanisms of Impaired Medical and Psychosocial Health Outcomes among Adolescents and Young Adults with Cancer: Protocol of the Prospective Observational COMPRAYA Cohort Study

“…Advances in cancer treatment have led to increased survival rates, however, even if patients survive and are cured, they are still at risk of the development of long-term medical (e.g., cardiovascular disease or second malignancies) or psychosocial (e.g., high distress levels [ 17 ], financial toxicity due to unemployment without a prior career job) long-term and late effects of cancer and its treatment, that may also increase the risk of late mortality [ 18 , 19 , 20 , 21 , 22 ]. The impact and consequences cancer has on AYA, including the gap in survival outcomes, differs from other age groups for several reasons [ 23 ]: Insufficient awareness of cancer risk and symptoms among AYA and healthcare professionals resulting in prolonged diagnostic trajectories [ 24 , 25 ]; Unique and incompletely understood tumor biology—cancers that are histologically indistinguishable across the age spectrum may be characterized by particular biological features in the AYA population [ 9 , 26 , 27 ]; Distinct age-related physiology, pharmacology, and genomic properties with respect to cancer susceptibility and treatment [ 9 ]; Unequal access to and low participation rates in clinical trials [ 1 ]; Lack of age-adjusted treatments [ 28 ] and age-specific psychosocial care—”I am treated like my 74-year-old grandma” [ 29 , 30 ]; Adolescence and emerging and young adulthood are complex phases of life due to the many physical, emotional, cognitive, and social transitions [ 31 ].…”