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Yusuf R, Ng DQ, Torno L, Chan A. Current evidence of integrative oncology modalities for managing adverse effects and survivorship issues among adolescents and young adult (AYA) cancer patients and survivors. Curr Opin Oncol 2024; 36:211-222. [PMID: 38842014 DOI: 10.1097/cco.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Symptom burden of cancer diagnosis and treatment has led adolescents and young adult cancer patients (AYAC) and survivors to seek different self-management strategies including integrative oncology (IO) modalities. IO holds great promise to improve survivorship issues in adolescents and young adult (AYA) cancer survivors. This review aims to encompass the current evidence of IO modalities and to analyze the efficacy of IO for managing survivorship issues among AYA cancer patients and survivors. RECENT FINDINGS Nineteen randomized controlled trials included in this review evaluated mind and body modalities including both physical and psychological (74%) and psychological only (26%) modalities. Most assessed IO modalities were physical activity (PA) (37%) and structured exercise (10%). Most effective IO modalities found were PA, massage, mindfulness-based stress reduction (MBSR) and light therapy for treating AYA symptom burden. The Cochrane risk of bias (RoB-2) concluded 21% studies had high risk, 58% possessed some concerns and 21% had low risk. SUMMARY Although evidence has shown that a number of IO modalities may improve survivorship among AYA cancer survivors, more rigorous study designs are needed in order for these modalities to be routinely recommended for use in clinical practice.
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Affiliation(s)
- Rukh Yusuf
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
| | - Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
| | - Lilibeth Torno
- Division of Oncology, Children's Hospital of Orange County, Orange, USA
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine
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2
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Kirchhoff AC, Waters AR, Chevrier A, Wolfson JA. Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature. J Clin Oncol 2024; 42:642-652. [PMID: 37939320 DOI: 10.1200/jco.23.01027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 11/10/2023] Open
Abstract
Access to care remains a persistent challenge for adolescents and young adults (AYAs) with cancer. We review key findings in the science to date. (1) Location of care matters. There is survival benefit for AYAs treated either at a pediatric center or site with special status (eg, Children's Oncology Group, National Cancer Institute [NCI]-designated Comprehensive Cancer Center). (2) Socioeconomic status and insurance require further investigation. Medicaid expansion has had a moderate effect on AYA outcomes. The dependent care expansion benefit has come largely from improvements in coverage for younger populations whose parents have insurance, while some subgroups likely still face insurance gaps. (3) Clinical trial enrollment remains poor, but access may be improving. Numerous barriers and facilitators of clinical trial enrollment include those that are system level and patient level. NCI has established several initiatives over the past decade to improve enrollment, and newer collaboratives have recently brought together multidisciplinary US teams to increase clinical trial enrollment. (4) Effective AYA programs require provider and system flexibility and program reflection. With flexibility comes a need for metrics to assess program effectiveness in the context of the program model. Centers treating AYAs with cancer could submit a subset of metrics (appropriate to their program and/or services) to maintain their status; persistence would require an entity with staying power committed to overseeing the metrics and the system. Substantial clinical and biological advances are anticipated over the next 20 years that will benefit all patients with cancer. In parallel, it is crucial to prioritize research regarding access to health care and cancer care delivery; only with equitable access to care for AYAs can they, too, benefit from these advances.
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Affiliation(s)
- Anne C Kirchhoff
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Amy Chevrier
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | - Julie A Wolfson
- Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Haines ER, Lux L, Stein J, Swift C, Matson M, Childers J, Kleissler D, Mayer DK, Steiner N, Steiner L, Rosenstein D, Gold S, Smitherman AB. Developing a Comprehensive Adolescent and Young Adult Cancer Program: Lessons Learned from 7 Years of Growth and Progress. J Adolesc Young Adult Oncol 2023; 12:868-878. [PMID: 37155196 PMCID: PMC10777816 DOI: 10.1089/jayao.2023.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Purpose: Every year, nearly 100,000 adolescents and young adults (15-39 years, AYAs) are diagnosed with cancer in the United States and many have unmet physical, psychosocial, and practical needs during and after cancer treatment. In response to demands for improved cancer care delivery for this population, specialized AYA cancer programs have emerged across the country. However, cancer centers face multilevel barriers to developing and implementing AYA cancer programs and would benefit from more robust guidance on how to approach AYA program development. Methods: To contribute to this guidance, we describe the development of an AYA cancer program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center. Results: We summarize the evolution of UNC's AYA Cancer Program since it was established in 2015, offering pragmatic strategies for developing, implementing, and sustaining AYA cancer programs. Conclusion: The development of the UNC AYA Cancer Program since 2015 has generated many lessons learned that we hope may be informative to other cancer centers seeking to build specialized services for AYAs.
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Affiliation(s)
- Emily R. Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lauren Lux
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Jacob Stein
- Division of Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Catherine Swift
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Melissa Matson
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Julie Childers
- UNC Adolescent and Young Adult Cancer Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Daniel Kleissler
- Office of Clinical and Translational Research in Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Deborah K. Mayer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lucy Steiner
- Be Loud! Sophie Foundation, Chapel Hill, North Carolina, USA
| | - Donald Rosenstein
- Comprehensive Cancer Support Program, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Stuart Gold
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Andrew B. Smitherman
- Pediatric Hematology-Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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4
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Haines E, Asad S, Lux L, Gan H, Noskoff K, Kumar B, Roggenkamp B, Salsman JM, Birken S. Guidance to Support the Implementation of Specialized Adolescent and Young Adult Cancer Care: A Qualitative Analysis of Cancer Programs. JCO Oncol Pract 2022; 18:e1513-e1521. [PMID: 35749679 PMCID: PMC9509058 DOI: 10.1200/op.22.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The nearly 90,000 adolescents and young adults (AYAs) diagnosed with cancer in the United States yearly have tended to occupy a no-man's land between medical and pediatric oncology, often reporting that existing models of care are misaligned with their needs and preferences. Although guidelines for optimal AYA cancer care are increasingly available, the implementation of such standards has been varied. This may be in part due to a lack of guidance for implementing specialized AYA care. In this study, we leveraged an implementation science framework to identify barriers and generate practical guidance to inform the implementation of specialized AYA cancer care. METHODS We conducted semistructured qualitative interviews, guided by the Consolidated Framework for Implementation Research, with AYA care stakeholders (N = 32 from 14 cancer programs). Our multidisciplinary research team analyzed interview transcriptions using a template analysis approach and gleaned from interviews practical guidance for implementing specialized AYA care. RESULTS Participants reported barriers to implementing specialized AYA care across all five Consolidated Framework for Implementation Research domains: (1) intervention characteristics (eg, costs), (2) inner setting (eg, difficulties in collaborating between pediatric and medical oncology), (3) outer setting (eg, patient-level barriers to participating in AYA services), (4) individual characteristics (eg, attitudes about AYA oncology), and (5) process (eg, lack of metrics for program evaluation). They also shared practical guidance for addressing these barriers. CONCLUSION Emerging guidance on the core elements of AYA cancer care must be matched with guidance to support the implementation of specialized AYA care. This study contributes to the body of evidence available to inform future implementation efforts.
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Affiliation(s)
- Emily Haines
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah Asad
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren Lux
- Comprehensive Cancer Support Program, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Psychiatry, University of North Carolina Chapel Hill, Chapel Hill, NC
| | | | | | | | | | - John M. Salsman
- Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC
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Taylor RM, Fern LA, Barber J, Gibson F, Lea S, Patel N, Morris S, Alvarez-Galvez J, Feltbower R, Hooker L, Martins A, Stark D, Raine R, Whelan JS. Specialist cancer services for teenagers and young adults in England: BRIGHTLIGHT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
When cancer occurs in teenagers and young adults, the impact is far beyond the physical disease and treatment burden. The effect on psychological, social, educational and other normal development can be profound. In addition, outcomes including improvements in survival and participation in clinical trials are poorer than in younger children and older adults with similar cancers. These unique circumstances have driven the development of care models specifically for teenagers and young adults with cancer, often focused on a dedicated purpose-designed patient environments supported by a multidisciplinary team with expertise in the needs of teenagers and young adults. In England, this is commissioned by NHS England and delivered through 13 principal treatment centres. There is a lack of evaluation that identifies the key components of specialist care for teenagers and young adults, and any improvement in outcomes and costs associated with it.
Objective
To determine whether or not specialist services for teenagers and young adults with cancer add value.
Design
A series of multiple-methods studies centred on a prospective longitudinal cohort of teenagers and young adults who were newly diagnosed with cancer.
Settings
Multiple settings, including an international Delphi study of health-care professionals, qualitative observation in specialist services for teenagers and young adults, and NHS trusts.
Participants
A total of 158 international teenage and young adult experts, 42 health-care professionals from across England, 1143 teenagers and young adults, and 518 caregivers.
Main outcome measures
The main outcomes were specific to each project: key areas of competence for the Delphi survey; culture of teenagers and young adults care in the case study; and unmet needs from the caregiver survey. The primary outcome for the cohort participants was quality of life and the cost to the NHS and patients in the health economic evaluation.
Data sources
Multiple sources were used, including responses from health-care professionals through a Delphi survey and face-to-face interviews, interview data from teenagers and young adults, the BRIGHTLIGHT survey to collect patient-reported data, patient-completed cost records, hospital clinical records, routinely collected NHS data and responses from primary caregivers.
Results
Competencies associated with specialist care for teenagers and young adults were identified from a Delphi study. The key to developing a culture of teenage and young adult care was time and commitment. An exposure variable, the teenagers and young adults Cancer Specialism Scale, was derived, allowing categorisation of patients to three groups, which were defined by the time spent in a principal treatment centre: SOME (some care in a principal treatment centre for teenagers and young adults, and the rest of their care in either a children’s or an adult cancer unit), ALL (all care in a principal treatment centre for teenagers and young adults) or NONE (no care in a principal treatment centre for teenagers and young adults). The cohort study showed that the NONE group was associated with superior quality of life, survival and health status from 6 months to 3 years after diagnosis. The ALL group was associated with faster rates of quality-of-life improvement from 6 months to 3 years after diagnosis. The SOME group was associated with poorer quality of life and slower improvement in quality of life over time. Economic analysis revealed that NHS costs and travel costs were similar between the NONE and ALL groups. The ALL group had greater out-of-pocket expenses, and the SOME group was associated with greater NHS costs and greater expense for patients. However, if caregivers had access to a principal treatment centre for teenagers and young adults (i.e. in the ALL or SOME groups), then they had fewer unmet support and information needs.
Limitations
Our definition of exposure to specialist care using Hospital Episode Statistics-determined time spent in hospital was insufficient to capture the detail of episodes or account for the variation in specialist services. Quality of life was measured first at 6 months, but an earlier measure may have shown different baselines.
Conclusions
We could not determine the added value of specialist cancer care for teenagers and young adults as defined using the teenage and young adult Cancer Specialism Scale and using quality of life as a primary end point. A group of patients (i.e. those defined as the SOME group) appeared to be less advantaged across a range of outcomes. There was variation in the extent to which principal treatment centres for teenagers and young adults were established, and the case study indicated that the culture of teenagers and young adults care required time to develop and embed. It will therefore be important to establish whether or not the evolution in services since 2012–14, when the cohort was recruited, improves quality of life and other patient-reported and clinical outcomes.
Future work
A determination of whether or not the SOME group has similar or improved quality of life and other patient-reported and clinical outcomes in current teenage and young adult service delivery is essential if principal treatment centres for teenagers and young adults are being commissioned to provide ‘joint care’ models with other providers.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- National Cancer Research Institute, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sarah Lea
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain
| | - Richard Feltbower
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Ana Martins
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dan Stark
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Jeremy S Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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6
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Fern LA, Taylor RM, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Processes of care and survival associated with treatment in specialist teenage and young adult cancer centres: results from the BRIGHTLIGHT cohort study. BMJ Open 2021; 11:e044854. [PMID: 33827838 PMCID: PMC8031022 DOI: 10.1136/bmjopen-2020-044854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Survival gains in teenagers and young adults (TYA) are reported to be lower than children and adults for some cancers. Place of care is implicated, influencing access to specialist TYA professionals and research.Consequently, age-appropriate specialist cancer care is advocated for TYA although systematic investigation of associated outcomes is lacking. In England, age-appropriate care is delivered through 13 Principal Treatment Centres (TYA-PTC). BRIGHTLIGHT is the national evaluation of TYA cancer services to examine outcomes associated with differing places and levels of care. We aimed to examine the association between exposure to TYA-PTC care, survival and documentation of clinical processes of care. DESIGN Prospective cohort study. SETTING 109 National Health Service (NHS) hospitals across England. PARTICIPANTS 1114 TYA, aged 13-24, newly diagnosed with cancer between 2012 and 2014. INTERVENTION Participants were assigned a TYA-PTC category dependent on the proportion of care delivered in a TYA-PTC in the first year after diagnosis: all care in a TYA-PTC (ALL-TYA-PTC, n=270), no care in a TYA-PTC (NO-TYA-PTC, n=359), and some care in a TYA-PTC with additional care in a children's/adult unit (SOME-TYA-PTC, n=419). PRIMARY OUTCOME Data were collected on documented processes indicative of age-appropriate care using clinical report forms, and survival through linkage to NHS databases. RESULTS TYA receiving NO-TYA-PTC care were less likely to have documentation of molecular diagnosis, be reviewed by a children's or TYA multidisciplinary team, be assessed by supportive care services or have a fertility discussion. There was no significant difference in survival according to category of care. There was weak evidence that the association between care category and survival differed by age (p=0.08) with higher HRs for those over 19 receiving ALL or SOME-TYA-PTC compared with NO-TYA-PTC. CONCLUSION TYA-PTC care was associated with better documentation of clinical processes associated with age-appropriate care but not improved survival.
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Affiliation(s)
- Lorna A Fern
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Clinical Trials, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
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Rae C, Shah N, De Pauw S, Costa A, Barr RD. System Performance Indicators for Adolescent and Young Adult Cancer Care and Control: A Scoping Review. J Adolesc Young Adult Oncol 2020; 9:1-11. [DOI: 10.1089/jayao.2019.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nishwa Shah
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonja De Pauw
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald D. Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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8
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Rae CS, Pole JD, Gupta S, Digout C, Szwajcer D, Flanders A, Srikanthan A, Hammond C, Schacter B, Barr RD, Rogers PC. Development of System Performance Indicators for Adolescent and Young Adult Cancer Care and Control in Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:74-88. [PMID: 31952676 DOI: 10.1016/j.jval.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To develop an expert-group, consensus-based list of system performance indicators to be used for monitoring, evaluating, and benchmarking progress for cancer care and control in adolescents and young adults (AYAs) in Canada. METHODS A national multidisciplinary panel of AYA oncology experts was convened; they prepared a literature review and undertook a brainstorming exercise to create a comprehensive list of indicators based on a previously defined framework for AYA cancer care and control in Canada. A modified Delphi process was then undertaken to cull the list based on 3 quick screen criteria. Three rounds of ranking were required. The fourth stage employed a face-to-face meeting, and the final stage utilized a survey to rank the indicators on the basis of importance and feasibility. RESULTS Nineteen participants contributed to the 5-stage process. From an initial list of 114 indicators, 14 were ultimately endorsed, representing 5 themes: active care, survivorship, psychosocial issues, palliative care, and research. The 5 highest ranked indicators were assessed as very to moderately feasible, with only a single indicator (clinical trial enrollment) in the top 5 assigned a least feasible ranking. CONCLUSION The 14 indicators provide a starting point for the development of a standard set of metrics for AYA cancer care and control in Canada and have potential for international utility.
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Affiliation(s)
- Charlene S Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario and Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Hematology/Oncology, Hospital for Sick Children and Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carol Digout
- Atlantic Provinces Pediatric Hematology Oncology Network, IWK Health Centre, Halifax, NS, Canada
| | | | | | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Chad Hammond
- Canadian Hospice Palliative Care Association and School of Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | | | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Paul C Rogers
- Division of Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, BC, Canada
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9
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Conry A, Peters M, Fried DB, Adams A, Campbell AW, Bearden JD, Siegel RD, Crosswell HE. Complete Response to Dual Immunotherapy in a Young Adult with Metastatic Alveolar Soft Part Sarcoma Enabled by a Drug Recovery Program in a Community Practice. J Adolesc Young Adult Oncol 2019; 9:449-452. [PMID: 31855495 DOI: 10.1089/jayao.2019.0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is an extremely rare tumor that frequently occurs in adolescent and young adults (AYA). Survival is poor for patients with metastatic and/or relapsed disease not amenable to local control, and limited therapeutic options are available. A major barrier to cancer care in the United States AYA population is lack of access to coordinated care and appropriate therapies for those who lack insurance or who are underinsured. We report a 25-year-old unemployed, uninsured, single mother who presented with a 12.8 × 21 cm soft tissue thigh mass with heterogeneous avidity, max standardized uptake value of 9, with metastatic disease to the ipsilateral inguinal lymph nodes and to the bilateral lungs. After local control of the primary mass was obtained, a recently developed, comprehensive drug replacement program (DRP) was used to gain access to nivolumab, and after frank progression was noted, ipilimumab was added every 6 weeks. No biomarkers associated with response to immunotherapy were identified. After four cycles, a complete response was observed and patient remains disease free 36 months after beginning dual immunotherapy treatment. We obtained immunotherapy agents through a DRP and describe the development and the utility of this program in the community setting. Our report highlights both first documented sustained complete response to sequenced immunotherapy in an AYA with ASPS as well as a comprehensive DRP, which enabled access to therapy for our patient.
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Affiliation(s)
- Alexandra Conry
- Bon Secours St. Francis Health System, St. Francis Cancer Center, Greenville, South Carolina, USA
| | - Melissa Peters
- Spartanburg Regional Health System, Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Daniel B Fried
- Spartanburg Regional Health System, Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Amy Adams
- Bon Secours St. Francis Health System, St. Francis Cancer Center, Greenville, South Carolina, USA
| | - Alfred W Campbell
- Spartanburg Regional Health System, Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - James D Bearden
- Spartanburg Regional Health System, Gibbs Cancer Center & Research Institute, Spartanburg, South Carolina, USA
| | - Robert D Siegel
- Bon Secours St. Francis Health System, St. Francis Cancer Center, Greenville, South Carolina, USA
| | - Howland E Crosswell
- Bon Secours St. Francis Health System, St. Francis Cancer Center, Greenville, South Carolina, USA
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Pettit T, Sue L, Waugh V, Ballantine K, Gardner K, Bremer L, Pemberton L, Allison L, Adams S, Chou E, Spearing R. An Age Stratified Analysis of the Access to Care Continuum Across Three Tumor Groups: Are There Delays for AYA? J Adolesc Young Adult Oncol 2019; 8:402-409. [DOI: 10.1089/jayao.2018.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tristan Pettit
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Louise Sue
- South Island Adolescent and Young Adult Cancer Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Val Waugh
- South Island Adolescent and Young Adult Cancer Service, Southern District Health Board, Dunedin, New Zealand
| | - Kirsten Ballantine
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Kate Gardner
- Department of Medical Oncology, Christchurch Hospital, Christchurch, New Zealand
| | - Louise Bremer
- Department of Medical Oncology and Dunedin Hospital, Dunedin, New Zealand
| | - Lucy Pemberton
- Department of Haematology, Dunedin Hospital, Dunedin, New Zealand
| | - Lucy Allison
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Savannah Adams
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Eunice Chou
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ruth Spearing
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
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Fardell JE, Patterson P, Wakefield CE, Signorelli C, Cohn RJ, Anazodo A, Zebrack B, Sansom-Daly UM. A Narrative Review of Models of Care for Adolescents and Young Adults with Cancer: Barriers and Recommendations. J Adolesc Young Adult Oncol 2018; 7:148-152. [DOI: 10.1089/jayao.2017.0100] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Joanna E. Fardell
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Pandora Patterson
- Department of Research, Evaluation and Social Policy, CanTeen Australia, Sydney, Australia
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - Claire E. Wakefield
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Christina Signorelli
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Richard J. Cohn
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Antoinette Anazodo
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Bradley Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Ursula M. Sansom-Daly
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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12
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Adolescent-young adults (AYA) with cancer seeking integrative oncology consultations: demographics, characteristics, and self-reported outcomes. Support Care Cancer 2017; 26:1161-1167. [DOI: 10.1007/s00520-017-3937-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
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13
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Hsiao CC, Chiou SS, Hsu HT, Lin PC, Liao YM, Wu LM. Adverse health outcomes and health concerns among survivors of various childhood cancers: Perspectives from mothers. Eur J Cancer Care (Engl) 2017; 27:e12661. [PMID: 28169481 DOI: 10.1111/ecc.12661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 01/08/2023]
Abstract
Advanced therapies have improved outcomes and also resulted in a growing risk of long-term adverse health events. This study intends to estimate incidences of adverse health events and examine differences in adverse health events among childhood cancer survivors, and to understand the concerns of mothers after their child has completed cancer treatment. An explanatory sequential mixed-method was used. A total of 201 paediatric cancer survivors' mothers with mean age 43.6 years were recruited. Of the survivors, 12.4% experienced five or more adverse health events. The incidence of adverse health events of altered body image, fatigue and neurocognitive problems were 31.54%, 14.77% and 12.53% respectively. Among survivors, significant differences in adverse health events of pain, endocrine problems and altered body image issues were identified. Survivors receiving radiotherapy, bone marrow transplants or completing treatment after 6-10 years experienced significantly more adverse health events. Maintaining health was the greatest concern for mothers, and the qualitative reports of their concerns could be categorised: living in uncertainty, and keeping forward-looking. Childhood brain tumour survivors were identified as experiencing more adverse health events than other survivors. The need for healthcare teams to consider mothers' health concerns was highlighted.
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Affiliation(s)
- C C Hsiao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S S Chiou
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - H-T Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - P C Lin
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Pediatrics, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Y M Liao
- Division of Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - L-M Wu
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Ferrari A, Silva M, Veneroni L, Magni C, Clerici CA, Meazza C, Terenziani M, Spreafico F, Chiaravalli S, Casanova M, Luksch R, Catania S, Schiavello E, Biassoni V, Podda M, Bergamaschi L, Puma N, Indini A, Proserpio T, Massimino M. Measuring the efficacy of a project for adolescents and young adults with cancer: A study from the Milan Youth Project. Pediatr Blood Cancer 2016; 63:2197-2204. [PMID: 27554940 DOI: 10.1002/pbc.26172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Various projects dedicated specifically to adolescents and young adults (AYA) with cancer have been developed in recent years. A critical aspect of such programs is the ability to demonstrate its value, and therefore how to measure desired outcomes. METHODS A list of metrics to consider for demonstrating the advantages of an AYA program was identified and used to assess the activity of the Youth Project operating at the Pediatric Oncology Unit of the Istituto Nazionale Tumori in Milan. RESULTS The number of newly diagnosed AYA patients seen at the Unit has increased since the formal launch of the Youth Project, from 65 to 81.2 cases/year. Concerning the 78 AYA patients presenting with malignant neoplasms in 2015, 82% were included in clinical trials (the other 18% in prospective observational studies). Fertility preservation measures were implemented for 59% of AYA patients considered at risk, and specific psychological support was provided in 70.6% of cases; 72.5% of patients actively participated in support activities. Other parameters considered were a preliminary satisfaction questionnaire administered to patients and the program's scientific recognition and acknowledgment by the community. CONCLUSIONS The study proposed a number of potentially reproducible, practical parameters to consider in assessing the value of a program dedicated to AYA. These metrics were examined in terms of the activities of our Youth Project, and confirmed its efficacy. To be sustainable over time, AYA projects have to be accepted as a standard of care at the community and government levels.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy.
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Carlo Alfredo Clerici
- Clinical Biology, Oncology and Hemato-Oncology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Alice Indini
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Tullio Proserpio
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Lombardia, Italy
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15
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Ramphal R, Aubin S, Czaykowski P, De Pauw S, Johnson A, McKillop S, Szwajcer D, Wilkins K, Rogers P. Adolescent and young adult cancer: principles of care. ACTA ACUST UNITED AC 2016; 23:204-9. [PMID: 27330350 DOI: 10.3747/co.23.3013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescents and young adults (ayas) with cancer in active treatment face a number of barriers to optimal care. In the present article, we focus on the 3 critical domains of care for ayas-medical, psychosocial, and research-and how changes to the system could overcome barriers. We summarize the current literature, outline recommended principles of care, raise awareness of barriers to optimal care, and suggest specific changes to the system to overcome those barriers in the Canadian context. Many of the recommendations can nevertheless be applied universally. These recommendations are endorsed by the Canadian Task Force on Adolescents and Young Adults with Cancer and build on outcomes from two international workshops held by that group.
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Affiliation(s)
- R Ramphal
- Division of Pediatric Hematology/Oncology, University of Ottawa, Ottawa, ON
| | - S Aubin
- Division of Gynecologic Oncology, McGill University, Montreal, QC
| | - P Czaykowski
- Division of Hematology/Oncology, University of Manitoba, Winnipeg, MB
| | - S De Pauw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - A Johnson
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, BC Children's Hospital and University of British Columbia, Vancouver, BC
| | - S McKillop
- Division of Pediatric Hematology/Oncology, University of Alberta, Edmonton, AB
| | - D Szwajcer
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB
| | - K Wilkins
- Faculty of Nursing, University of New Brunswick, Fredericton, NB
| | - P Rogers
- Division of Hematology/Oncology, University of Manitoba, Winnipeg, MB
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16
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Agarwal A, Thaker NG, Tawk B, Allen PK, Grosshans DR, Herzog CE, Gombos DS, Mahajan A. The Evolution of Radiation Therapy for Retinoblastoma: The MD Anderson Cancer Center Experience. Int J Part Ther 2016; 2:490-498. [PMID: 31772961 DOI: 10.14338/ijpt-15-00016.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose The role of radiation therapy (RT) for retinoblastoma (Rb) has significantly evolved from first-line to salvage therapy. The objectives of our study were to evaluate efficacy of proton RT (PRT) and other advanced RT techniques for Rb and to observe evolving trends in RT use. Materials and Methods An analysis of patients with Rb who received RT between 1990 and 2012 was conducted. Thirty-nine patients with 70 affected eyes were identified. Of these, 47 eyes were treated with RT with photon or electron RT (ERT), PRT, or brachytherapy (BRT). The clinical history, treatment details, and tumor outcomes were reviewed for all patients. Results Radiation therapy was first-line treatment in 14 eyes, second-line in 4, postoperative in 4, and salvage in 25. Median length of follow-up was 8 years for all patients, and 10, 3, and 5 years for ERT, PRT, and BRT, respectively. Overall survival was 97.4%. In total, 16 (34.0%) eyes required enucleation after RT. Median PRT dose was 36 Gy (RBE) (range, 36-45 Gy [RBE]), ERT dose was 45 Gy (range, 36-46 Gy), and BRT dose was 45 Gy (range, 36-45 Gy). A higher proportion of PRT patients (93.8%) than ERT patients (51.9%) were treated in the salvage setting (P < .01). Among patients with International Classification for Intraocular Retinoblastoma stage D and E disease, 6 of 11 (54.5%) ERT patients required enucleation and 5 of 13 (38.5%) PRT patients required enucleation. Conclusion This study represents a large series of patients treated with PRT, ERT, and BRT for Rb and reports favorable efficacy and toxicity. Patients treated with salvage PRT are typically heavily pretreated and have advanced disease. Despite more advanced disease, patients treated with PRT with lower RT doses achieve comparable salvage and enucleation-free rates to ERT. Chemoreduction followed by focal treatments should be standard of care when clinically feasible, with PRT considered in the salvage setting.
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Affiliation(s)
- Ankit Agarwal
- Department of Radiation Oncology, Boston University School of Medicine, Boston, MA, USA
| | - Nikhil G Thaker
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bouchra Tawk
- Molecular & Translational Radiation Oncology, Heidelberg Ion Therapy Center (HIT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cynthia E Herzog
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel S Gombos
- Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Xu Y, Stavrides-Eid M, Baig A, Cardoso M, Rho YS, Shams WM, Mamo A, Kavan P. Quantifying treatment delays in adolescents and young adults with cancer at McGill University. ACTA ACUST UNITED AC 2015; 22:e470-7. [PMID: 26715885 DOI: 10.3747/co.22.2724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Since the end of the 1980s, the magnitude of survival prolongation or mortality reduction has not been the same for adolescents and young adults (ayas) with cancer as for their older and younger counterparts. Precise reasons for those observations are unknown, but the differences have been attributed in part to delays in diagnosis and treatment. In 2003 at the Jewish General Hospital, we developed the first Canadian multidisciplinary aya oncology clinic to better serve this unique patient population. The aim of the present study was to develop an approach to quantify diagnosis delays in our aya patients and to study survival in relation to the observed delay. METHODS In a retrospective chart review, we collected information about delays, treatment efficacy, and obstacles to treatment for patients seen at our aya clinic. RESULTS From symptom onset, median time to first health care contact was longer for girls and young women (62 days) than for boys and young men (6 days). Median time from symptom onset to treatment was 173 days; time from first health care contact to diagnosis was the largest contributor to that duration. Delays in diagnosis were shorter for patients who initially presented to the emergency room, but compared with patients whose first health contact was of another type, patients presenting to the emergency room were 3 times more likely to die from their disease. CONCLUSIONS Delays in diagnosis are frequently reported in ayas with cancer, but the duration of the delay was unrelated to survival in our sample. Application of this approach to larger prospective samples is warranted to better understand the relation between treatment delay and survival in ayas-and in other cancer patient groups.
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Affiliation(s)
- Y Xu
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - M Stavrides-Eid
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - A Baig
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - M Cardoso
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - Y S Rho
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - W M Shams
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - A Mamo
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
| | - P Kavan
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC
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18
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Rogers PC, De Pauw S, Schacter B, Barr RD. A Process for Change in the Care of Adolescents and Young Adults with Cancer in Canada. "Moving to Action": The Second Canadian International Workshop. International Perspectives on AYAO, Part 1. J Adolesc Young Adult Oncol 2013; 2:72-76. [PMID: 23781404 DOI: 10.1089/jayao.2012.0034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Canadian National Adolescent and Young Adult Cancer Task Force (NTF) held its second international workshop in Toronto during March 2012. The workshop's theme, "Moving to Action," focused on implementing the NTF's recommendations, published previously in the Journal of Adolescent and Young Adult Oncology. Here we provide a review of the NTF's process of engagement and actions in order to advocate for and implement a change process in the care of AYA patients in Canada. The highlights of the second international workshop and components of the resulting "Framework for Action" are reported.
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Affiliation(s)
- Paul C Rogers
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, BC Children's Hospital and University of British Columbia , Vancouver, British Columbia, Canada
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19
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Miedema B, Easley J, Robinson LM. Do current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada? A qualitative inquiry. ACTA ACUST UNITED AC 2013; 20:14-22. [PMID: 23443642 DOI: 10.3747/co.20.1207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the present study was to assess whether current cancer follow-up care practices meet the needs of young adult cancer survivors in Canada. METHODS This qualitative study used a constructivist grounded theory framework to analyze telephone interviews with cancer survivors from across Canada diagnosed between the ages of 18 and 39 years. The focus was specifically on cancer follow-up care (cfc). RESULTS Interviews were conducted with 55 participants, and 53 interviews were used for the analysis. The overall theme that emerged from the data was the lack of age-specific cfc. Some of the subthemes that emerged were the absence or inadequacy of fertility and infertility treatment options; of psychological services such as family, couples, and sexuality counseling; of social supports such as assistance with entry or re-entry into the education system or workplace; of access to supplemental health insurance; and of survivorship care plans. Based on the data resulting from the interviews, we developed a conceptual model of young-adult cfc incorporating the major themes and subthemes that emerged from our study. The proposed model aims to ensure a more age-appropriate and comprehensive approach to cfc for this group of cancer patients. CONCLUSIONS Current Canadian cfc practices are inadequate and do not provide comprehensive care for young adult cancer survivors in Canada. The conceptual model presented here aims to ensure a more comprehensive approach to cfc that meets the needs of this unique cancer population and reduces further possible physical, psychological, or social cancer sequelae.
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Affiliation(s)
- B Miedema
- Dalhousie University Family Medicine Teaching Unit, Fredericton, NB
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20
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Abstract
Adolescents and young adults (AYAs) with cancer represent a unique and challenging group of patients with distinct developmental and psychosocial needs that may be unrecognized or unmet during their cancer experience. Palliative care refers to the total care of a patient, regardless of his or her disease status, and aims to improve quality of life by controlling symptoms and alleviating physical, social, psychological, and spiritual suffering. Integrating palliative care into standard oncology practice for AYAs is therefore valuable, if not imperative, in improving their overall cancer experience. In this review, we aimed to describe the scope, benefits, and challenges of palliative care for AYA oncology patients. We provide a broad impression of the existing literature describing or investigating palliative care in this population. Put together, the evidence suggests that palliative care is not only needed, but can also be critically beneficial to patients, families, and health care professionals alike. As we increase public and professional awareness of the needs and applications of palliative care for AYA patients with cancer, we will ultimately enable better psychosocial outcomes of the AYA patients and their larger communities.
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Affiliation(s)
- Abby R Rosenberg
- Division of Pediatric Hematology/ Oncology, Seattle Children's Hospital, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Pediatrics, University of Washington, Seattle, WA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care/Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Medicine/Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA.,Department of Pediatrics, Harvard University School of Medicine, Boston, MA, USA
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21
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Abstract
Adolescents and young adults (AYA) with advanced or terminal cancer have distinctive medical and psychosocial needs that may not have been adequately provided by either pediatric or adult palliative care services. A discussion group, as part of a larger workshop on AYA with cancer, was held in Toronto on March 11-13, 2010;117:-. Recommendations were as follows: Develop a specific AYA screening tool designed to detect increased anxiety or new symptoms and to initiate discussion about palliative or symptom care; Set Canadian standards for palliative care in AYA patients. These standards should be included in hospital accreditation; Involve the palliative/symptom care team early in the disease trajectory to help manage clinically important symptoms that may not be associated with imminent death; Establish specific AYA multidisciplinary palliative care teams throughout Canada that are flexible and can work in both pediatric and adult facilities, and are able to work in a "virtual" environment to support patients being cared for at home; Improve physical facilities in hospices and hospitals to meet the distinctive needs of terminally ill AYA patients; Enhance support for palliative care at home by: changing legislation to improve Compassionate Care Benefits and developing "virtual palliative care support teams". Adequate provision of AYA palliative care and symptom management services will likely confer notable benefits to AYA patients and their families, and is likely to be cost saving to the tax payer by avoiding prolonged hospitalization and promoting easier return to work for the families and caregivers.
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Affiliation(s)
- Abby R Rosenberg
- Division of Pediatric Hematology/Oncology, Seattle Children’s Hospital, Seattle, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care/Division of Pediatric Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine/Division of Hematology/Oncology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard University School of Medicine, Boston, MA, USA
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