Cancer in adolescents and young adults: treatment and outcome in Victoria

Abstract

Objectives: To describe the location of treatment, recruitment to clinical trials and outcomes for adolescents and young adults treated for cancer in Victoria. Design and setting: Retrospective review of all adolescents and young adults aged 10–24 years diagnosed with cancer between 1992 and 1996, identified from the Victorian Cancer Registry. Main outcome measures: Treatment regimen (clinical trial, treatment protocol or neither), compliance with treatment and 5‐year survival. Results: Questionnaires were completed for 576 of 665 eligible adolescents and young adults (87% response rate). Recruitment into clinical trials decreased with increasing age. Adolescents aged 10–19 years were more likely to be recruited to a clinical trial if treated at a paediatric hospital. For all cancers, 5‐year survival was similar across the age groups and was not influenced by the place of treatment. Only 1% of adolescents and young adults failed to complete planned therapy due to non‐compliance. Conclusions: Despite a similar incidence of cancer to that in younger children, adolescents and young adults with cancer are poorly recruited into clinical trials in Victoria. Establishment of a cancer resource network in Victoria may provide information to both paediatric and adult oncologists about currently available clinical trials.

Treatment Setting, Clinical Trial Enrollment, and Subsequent Outcomes Among Adolescents With Cancer: A Literature Review

“…19 Another study found that only 14% of adolescents aged 16 to 19 years were treated at a pediatric institution. 20 …”

“…Of 91 cases with new cancer diagnoses treated at the pediatric center, 24 (26%) were enrolled, whereas only 5 of 121 (4%) cases with new cancer diagnoses treated at the adult center were enrolled in a clinical trial 24 A study in Australia showed that adolescents aged 10 to 19 years were more likely to be enrolled in a clinical trial if treated at a pediatric institution rather than at an adult institution (38% vs 3%). 20 Even if adolescents are seen at a pediatric institution, appropriate clinical trials may not be available. In a study in 640 patients with newly diagnosed cancer at a pediatric institution, 38% of patients under the age of 15 years were enrolled in a clinical trial and 27% of patients aged 15 to 22 years were enrolled in a clinical trial 25 More than half of the older patients were not enrolled because a trial was not available.…”

Intra-patient dose escalation in Ewing’s sarcoma treated with vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide and etoposide: a retrospective review

“…Although the peak incidence of ESFT is during the AYA years, these patients have a worse survival compared to a pediatric population [27]. The reasons behind this comprise a combination of biological differences [27,28], delayed diagnosis, poorer treatment compliance [29,30], psychosocial overlay and limited involvement in clinical trials [31,32]. With regards to biological differences, in the EURO-Ewing 99 protocol [10], increasing age and male gender was associated with less toxicity using VIDE chemotherapy, a protocol similar to VDC/IE.…”

Cancer Risks for Relatives of Children with Cancer

“…It was established from the clinical services at the Royal Children's Hospital (RCH) and the Monash Medical Centre (MMC), between which over 95% of children under 10 years of age and 83% of children aged 10–15 years with cancer within the State of Victoria, Australia, are treated [8]. Children were eligible for inclusion if they had a diagnosis of any cancer before age 15 and when initial treatment was given at one of the participating centres between October 1998 and October 2002.…”