Challenges for Cancer Care Delivery to Adolescents and Young Adults: Present and Future

Abstract

Adolescents and young adults occupy a unique place within the cancer community due to the challenges they face related to disease biology, access to care, and psychosocial and socioeconomic circumstances. Efforts to define specific needs and targets for intervention in these areas are under way and evolving. This review will discuss the current and future challenges in delivering quality care to this population.

Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter?

“…[19][20][21] Cancer care delay (or ''cancer delay'') among AYAs is a multifaceted and understudied challenge to the delivery of high-quality care. 22 In the U.S., only a small minority of AYA cancer patients are treated within specific AYA-focused programs. Poor communication and lack of collaboration between medical services are a potential source of both inappropriate therapeutic strategies and treatment delay in AYAs.…”

Psychosocial challenges and health-related quality of life of adolescents and young adults with hematologic malignancies

“…When compared with pediatric and older adult oncology patients, those aged 15 to 39 years at cancer diagnosis encounter differences in tumor biology, psychosocial challenges, and issues related to access to care and long-term follow-up. 1,2 AYAs typically present with hematologic malignancies (HMs) that span the spectrum from pediatric cancers (eg, acute lymphoblastic leukemia [ALL]) to adult tumors (non-Hodgkin lymphoma [NHL]), as well as tumors that are most common among their age group (Hodgkin lymphoma [HL]). 3 HMs form 34% of cancers diagnosed among AYAs aged 15 to 19 years (15% HL; 7% NHL; 7% ALL; 5% acute myeloid leukemia [AML]), 21% among those aged 20 to 29 years (10% HL; 6% NHL; 2% ALL; 3% AML), and 11% among 30-to 39-year olds (3% HL; 6% NHL; 1% ALL; 1% AML) in the western world.…”

“…3 HMs form 34% of cancers diagnosed among AYAs aged 15 to 19 years (15% HL; 7% NHL; 7% ALL; 5% acute myeloid leukemia [AML]), 21% among those aged 20 to 29 years (10% HL; 6% NHL; 2% ALL; 3% AML), and 11% among 30-to 39-year olds (3% HL; 6% NHL; 1% ALL; 1% AML) in the western world. 1,[3][4][5] For these patients, the 5-year overall survival varies between 50% and 95%. 6 Although survival in AYAs has improved over time, progress made in treatments and survival of specific tumors (eg, ALL and AML) lags behind that of children and older adults.…”

“…6 Although survival in AYAs has improved over time, progress made in treatments and survival of specific tumors (eg, ALL and AML) lags behind that of children and older adults. 5,6 Potential reasons for the lack of progress in survival are: the diverse and incompletely understood tumor biology 7 ; insufficient awareness of cancer risk and symptoms among patients and health care professionals (HCPs) resulting in diagnostic delays [8][9][10] ; unequal access to, and low participation rates in, clinical trials 1 ; treatment nonadherence rates of 27% to 60% 11 ; and limited knowledge among HCPs regarding AYA treatment protocols. 12 Education Cancer treatment can lead to serious disruption in educational trajectories, 28,29 with AYAs often missing coursework/ exams at a time that is crucial to future career development.…”

Trends in survival of leukemia among children, adolescents, and young adults: A population‐based study in Osaka, Japan

“…On the other hand, since 1974, the Japanese government has subsidized medical expenses for children and adolescents (under 18 years of age) with cancer, 5 and a public long‐term care insurance system is available for Japanese residents aged over 40 years from 2000. Financial issues for AYAs have been reported to be a barrier to care at specialized hospitals and consequently contribute to poor outcomes 9,41 . Although the data in our study do not include financial details, considering that financial support for patients aged 19 to 39 years is inadequate compared with other age groups, governmental financial support might be important not only for children but also AYAs.…”