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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: 0] [Impact Index Per Article: 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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2
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Myers AL, Fussell JJ, Moffatt ME, Boyer D, Ross R, Dammann CEL, Degnon L, Weiss P, Sauer C, Vinci RJ. The Importance of Subspecialty Pediatricians to the Health and Wellbeing of the Nation's Children. J Pediatr 2023:13365. [PMID: 36894130 DOI: 10.1016/j.jpeds.2023.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
Through this review of published literature, it is clear that children benefit in measurable ways when they receive care from trained pediatric subspecialists. The improved outcomes provided by pediatric subspecialists supports the care provided in the patient's pediatric medical home and emphasizes the importance of care coordination between all components of the pediatric workforce. The AAP highlights this in a recent policy statement by stating the care provided by pediatric clinicians "encompasses diagnosis and treatment of acute and chronic health disorders; management of serious and life-threatening illnesses; and when appropriate, referral of patients with more complex conditions for medical subspecialty or surgical specialty care" Explicit in this statement is the emphasis on the role of complex care coordination between pediatric specialist and primary care pediatricians and that collaboration and guidance by the pediatrician is central to providing optimal care of patients. 65 Improving health outcomes early in life is an important public health strategy for modifying the complications from childhood chronic disease and highlights the role of pediatricians in mitigating the long-term consequences of antecedents of adult disease. 66 The recent announcement of the National Academies of Science, Engineering, and Medicine (NASEM)'s plan for a Consensus Study on The Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-being is a related and exciting development, on a national scale. 67 In response to shortages and geographic maldistributions of pediatric subspecialists, the NASEM committee intends to assess the impact of current pediatric clinical workforce trends on child health and well-being, in order to develop informed strategies to ensure an adequate, high-quality pediatric workforce, with a robust research portfolio that informs those recommendations. While this large, national initiative will surely lead to a better understanding of and strategies to implement across the pediatric subspecialty workforce, more well-designed studies that specifically measure child outcomes related to access to pediatric subspecialty care, would add meaningfully to the body of pediatric literature and to our national pediatric advocacy initiatives.
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Affiliation(s)
- Angela L Myers
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Jill J Fussell
- Professor, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR
| | - Mary E Moffatt
- Professor of Pediatrics, Children's Mercy, Kansas City, University of Missouri-Kansas City, KC, MO
| | - Debra Boyer
- DIO/Chief Medical Education Officer, Professor of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Robert Ross
- Children's Hospital of Michigan, Professor of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | | | | | - Pnina Weiss
- Professor of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Cary Sauer
- Professor of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Robert J Vinci
- Professor of Pediatrics, Boston University School of Medicine, Boston, MA
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3
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Mortazavi M, Baxter NN, Gupta S, Gupta AA, Lau C, Nagamuthu C, Nathan PC. Impact of locus of care on outcomes in adolescents and young adults with osteosarcoma and Ewing sarcoma treated at pediatric versus adult cancer centers: An IMPACT cohort study. Pediatr Blood Cancer 2022; 69:e29458. [PMID: 35029312 DOI: 10.1002/pbc.29458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Location of cancer care (LOC; pediatric vs. adult center) impacts outcomes in adolescents and young adults (AYA) with some cancer types. Data on the impact of LOC on survival in AYA with osteosarcoma (OSS) and Ewing sarcoma (EWS) are limited OBJECTIVES: To compare differences in demographics, disease/treatment characteristics, and survival in a population-based cohort of AYA with OSS or EWS treated at pediatric versus adult centers METHODS: The Initiative to Maximize Progress in Adolescent Cancer Therapy (IMPACT) cohort captured demographic, disease, and treatment data for all AYA (15-21 years old) diagnosed with OSS and EWS in Ontario, Canada between 1992 and 2012. Patients were linked to provincial administrative health care databases. Outcomes were compared between patients treated in pediatric versus adult centers. RESULTS One hundred thirty-seven AYA were diagnosed with OSS (LOC: 47 pediatric, 90 adult) and 84 with EWS (38 pediatric, 46 adult). AYA treated at pediatric centers were more likely to be enrolled in a clinical trial (OSS 55% vs. 1%, p < .001; EWS 53% vs. 2%, p < .001) and received higher cumulative chemotherapy doses. Five-year event-free survival (EFS ± standard error) in OSS and EWS were 47% ± 4% and 43% ± 5%, respectively. In multivariable analysis, the impact of LOC (pediatric vs. adult center) on EFS in OSS (adjusted hazard ratio [HR] 1.15, 95% confidence interval [CI]: 0.58-2.27, p = .69) and EWS (adjusted HR 1.82, 95% CI: 0.97-3.43, p = .06) was not statistically significant. CONCLUSION Despite disparities in trial participation and chemotherapy doses, outcomes did not differ by LOC suggesting that AYA with bone tumors can be treated at either pediatric or adult centers.
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Affiliation(s)
- Mohammadreza Mortazavi
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Cancer Research Program, ICES, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Cancer Research Program, ICES, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Sumit Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Cancer Research Program, ICES, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Abha A Gupta
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Cindy Lau
- Cancer Research Program, ICES, Toronto, Ontario, Canada
| | | | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Cancer Research Program, ICES, Toronto, Ontario, Canada.,Institute for Health Policy, Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
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Collins CL, Peng J, Singh S, Hamilton AS, Freyer DR. Patterns of Cancer Care and Association with Survival among Younger Adolescents and Young Adults: A Population-Based Retrospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2105-2113. [PMID: 34479948 PMCID: PMC9306345 DOI: 10.1158/1055-9965.epi-21-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/23/2021] [Accepted: 08/24/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Younger adolescents and young adults (AYA) may receive care from either adult or pediatric oncologists. We explored patterns of care in this population and whether survival is associated with provider type. METHODS Utilizing the California Cancer Registry, we examined a cohort of 9,993 AYAs diagnosed with cancer aged 15 to 24 years from 1999 to 2008. Provider type (adult/pediatric) was determined by individual physician identifiers. For provider type, multivariable logistic regression models were adjusted for age, sex, race/ethnicity, socioeconomic status, diagnosis, and stage. For observed survival, Cox proportional hazard models were additionally adjusted for provider type. ORs and HR with 95% confidence intervals (95% CI) were determined. RESULTS Most patients saw adult providers (87.3% overall; 72.7% aged 15-19 years). Patients with acute leukemia, sarcoma, and central nervous system (CNS) malignancies more often saw pediatric providers [OR (95% CI) adult versus pediatric 0.48 (0.39-0.59), 0.74 (0.60-0.92), 0.76 (0.60-0.96), respectively]; those with germ cell tumors and other cancers, including carcinomas, more often saw adult providers [2.26 (1.72-2.98), 1.79 (1.41-2.27), respectively]. In aggregate and for most cancers individually, there was no survival difference by provider type [overall HR (95% CI) 1.00 (0.86-1.18)]. Higher survival was associated with pediatric providers for CNS malignancies [1.63 (1.12-2.37)] and rhabdomyosarcoma [2.22 (1.03-4.76)], and with adult providers for non-Hodgkin lymphoma [0.61 (0.39-0.96)]. CONCLUSIONS Most AYAs 15 to 24 years old are treated by medical oncologists. In general, survival was not associated with provider type. IMPACT Current patterns of care for this population support increased collaboration between medical and pediatric oncology, including joint clinical trials.
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Affiliation(s)
- Chelsea L. Collins
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.,Corresponding Author: Chelsea L. Collins, Department of Pediatrics, Loma Linda University, 11175 Campus Street, Coleman Pavilion, A1120, Loma Linda, CA 92350. Phone: 909–558–8626; Fax: 909–558–0479; E-mail:
| | - Jiahao Peng
- Loma Linda University School of Public Health, Loma Linda, California
| | - Sharn Singh
- Loma Linda University School of Public Health, Loma Linda, California
| | - Ann S. Hamilton
- Los Angeles Cancer Surveillance Program and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - David R. Freyer
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Cancer and Blood Diseases Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.,USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Jouglar E, Escande A, Martin V, Demoor-Goldschmidt C, Carrie C, Claude L, Bernier-Chastagner V. [Influence of age on indications and modalities of radiation therapy: What to keep in mind for adolescents and young adults?]. Bull Cancer 2020; 108:203-209. [PMID: 33051053 DOI: 10.1016/j.bulcan.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/25/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
When using radiation therapy for adolescents and young adults (AYA), paediatricians, adults' oncologists and radiation oncologists need to keep in mind several particularities through the whole therapeutic process. They embrace the indication, target volumes, prescribed dose, treatment techniques and follow-up. Indeed, the young age and the cancer features that characterised this population influence the modalities of irradiation. This article highlights the key points of AYA care with radiation therapy.
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Affiliation(s)
- Emmanuel Jouglar
- Institut de cancérologie de l'ouest, service de radiothérapie, boulevard Jacques-Monod, 44800 Saint-Herblain, France.
| | - Alexandre Escande
- Centre Oscar-Lambret, département universitaire de radiothérapie, 59800 Lille, France; Université de Lille 3, faculté Henri-Warembourg, Laboratoire cristal UMR 9189, 59800 Lille, France
| | - Valentine Martin
- Gustave-Roussy, département universitaire de radiothérapie, 94800 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Université Paris-Saclay, Université Paris-Sud, UVSQ, cancer et radiothérapie, Inserm U1018, 94800 Villejuif, France
| | - Christian Carrie
- Centre Léon-Berard, département de radiothérapie, 69008 Lyon, France
| | - Line Claude
- Centre Léon-Berard, département de radiothérapie, 69008 Lyon, France
| | - Valérie Bernier-Chastagner
- Institut de cancérologie de Lorraine, département de radiothérapie, 3, avenue de Bourgogne, 54500 Vandoeuvre-lès-Nancy, France
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Alken S, Owens C, Gilham C, Grant C, Pears J, Deady S, O'Marcaigh A, Capra M, O'Mahony D, Smith O, Walsh PM. Survival of childhood and adolescent/young adult (AYA) cancer patients in Ireland during 1994-2013: comparisons by age. Ir J Med Sci 2020; 189:1223-1236. [PMID: 32424602 DOI: 10.1007/s11845-020-02236-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some studies indicate that survival of adolescents and young adults (AYA) with cancer may be inferior to that of younger children with similar cancers, possibly related (in part) to differences in access to centralized or standardized treatment. AIMS This study aims to evaluate differences in survival for AYA patients when compared with paediatric patients treated in Ireland over a 20-year time period. METHODS This study compares relative survival for patients diagnosed in Ireland at ages 0-15 (paediatric group) and 16-24 (AYA group) during 1994-2013, followed to the end of 2014, for cancers defined by the International Classification of Childhood Cancer (ICCC) (Third Edition) group or subgroup. Five-year relative survival estimates, and excess hazard ratios (EHR) comparing excess mortality associated with a cancer diagnosis among AYA with that in the paediatric group, are presented. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. RESULTS Significantly higher excess mortality was found for AYA with leukaemias, lymphomas, astrocytomas, malignant bone tumours, and Ewing and related bone sarcomas, soft tissue sarcomas and 'other/unspecified' epithelial cancers, rhabdomyosarcomas, and 'other and unspecified' carcinomas. In contrast, lower excess mortality was found in the AYA group for all cancers and intracranial/intraspinal tumours, and for gliomas other than astrocytomas or ependymomas. Comparing 1994-2003 and 2004-2013 cohorts, age-related survival differences narrowed for lymphoid leukaemias, but widened for all cancers combined and intracranial/intraspinal tumours combined. Centralization of services varied depending upon cancer subtype, with leukaemias, CNS tumours and bone sarcomas most centralized. Within these, improvements in survival for leukaemias and CNS tumours have been seen for the AYA population. CONCLUSIONS Reasons for age-related survival differences, and differences in time-trend by age group, are not clear. The significant narrowing of survival differences by age in more recent years for lymphoid leukaemias reflects a more marked recent increase in survival among AYA. More work is required to explain and improve other age-related survival differences.
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Affiliation(s)
- Scheryll Alken
- St James's Hospital, Dublin, Ireland.
- Children's Health Ireland, Crumlin, Dublin, Ireland.
| | - Cormac Owens
- Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Charles Gilham
- St Luke's Radiation Oncology Network, Rathgar, Dublin, Ireland
| | | | - Jane Pears
- Children's Health Ireland, Crumlin, Dublin, Ireland
| | | | | | | | | | - Owen Smith
- Children's Health Ireland, Crumlin, Dublin, Ireland
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Nathan PC, Bremner KE, Liu N, Gupta S, Greenberg ML, McBride ML, Krahn MD, de Oliveira C. Resource Utilization and Costs in Adolescents Treated for Cancer in Pediatric vs Adult Institutions. J Natl Cancer Inst 2020; 111:322-330. [PMID: 30053118 DOI: 10.1093/jnci/djy119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Adolescents with cancer can receive care in pediatric or adult institutions. Survival often differs by locus, but little is known about relative health care utilization and costs. We estimated these in a population-based cohort of adolescents. METHODS All Ontario adolescents (15.0-17.9 years) diagnosed with cancer between 1995 and 2010 were identified from provincial cancer registries. We compared health care resource utilization (hospitalizations, emergency department visits, same-day surgeries, outpatient chemotherapy, radiation, diagnostic/laboratory tests, physician services, home care) and costs (2012 Canadian dollars) during four discrete care phases-prediagnosis (60 days), initial (360 days), continuing (variable), and terminal (360 days)-between adolescents treated in pediatric vs adult institutions, for the whole cohort and within seven diagnostic categories. All statistical tests were two-sided. RESULTS Of 1356 eligible adolescents, 691 and 665 were treated in adult and pediatric institutions, respectively. Hospitalization rates were higher in pediatric institutions during prediagnosis (14.9% vs 6.9%, P < .001), initial (95.1% vs 73.3%, P < .001), and continuing phases (43.2% vs 34.4%, P = .002), but similar (96.1% vs 96.3%, P = .93) during the terminal phase. Average length of stay was higher at pediatric institutions within most diagnoses and phases. For all diagnoses, median initial phase costs were higher in pediatric than adult institutions (eg, leukemia: $153 926 vs $102 418 per 360 days, P < .001; lymphoma: $65 025 vs $19 846, P < .001, respectively). CONCLUSIONS The costs of caring for adolescents with the same malignancy are considerably higher in pediatric than adult institutions during most phases. Resource utilization, particularly hospitalization, drives much of the cost difference, making these data applicable to other jurisdictions.
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Affiliation(s)
- Paul C Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Karen E Bremner
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Mark L Greenberg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, Toronto, ON, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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Osborn M, Johnson R, Thompson K, Anazodo A, Albritton K, Ferrari A, Stark D. Models of care for adolescent and young adult cancer programs. Pediatr Blood Cancer 2019; 66:e27991. [PMID: 31524328 DOI: 10.1002/pbc.27991] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/30/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022]
Abstract
This review draws on the experience of adolescent and young adult (AYA) cancer clinicians from Australia, the United States, and the United Kingdom to summarize common aspects of models of care implemented in their countries. The principles underpinning these models include patient- and family-focused care informed by an understanding of normal AYA development, enhancing existing adult or pediatric cancer services to meet the needs of AYA, and promoting collaboration between pediatric and adult oncologists. Common elements of AYA cancer care include establishing an AYA multidisciplinary team that integrates medical and psychosocial care, efforts to centralize complex care, providing access and equity for all AYA, promoting clinical trials, and helping facilitate transition to healthy survivorship. Several organizational approaches are described, noting that local program development depends on resources, infrastructure, and assessment of unmet needs within the region. The development of national networks provides opportunities for shared learning and approaches to evaluation.
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Affiliation(s)
- Michael Osborn
- Youth Cancer Service SA/NT, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Rebecca Johnson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Adolescent and Young Adult Oncology Program, Mary Bridge Children's Health Center/MultiCare Health System, Tacoma, Washington
| | - Kate Thompson
- OnTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.,Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Karen Albritton
- Adolescent and Young Adult Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Daniel Stark
- The Leeds Institute of Cancer and Pathology, Leeds Institute of Oncology and St James's University Hospital, Leeds, UK
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Abstract
Adolescents and young adults (AYAs) with cancer constitute a particular group of patients with unique features, whose needs during and after treatment are poorly met. A standardized model of care for them has yet to be established, as neither the pediatric nor the adult oncology systems seamlessly fit their needs. Regardless of the setting in which they are treated, their health care providers should be aware of the impact that the disease and its treatments have on these especially vulnerable patients. Simple ways of improving the AYA experience should be considered: reducing isolation through connections with peers, adapting the staff's approach to the emotional and developmental needs of this age group, and modifying the hospital environment making it more age appropriate. Commitment of national governments is valuable; building and sharing international experience will accelerate advances in clinical care, education, and research. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.
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10
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Spraker-Perlman H, Smits-Seeman RR, Li H, Kirchhoff AC. Statewide Treatment Center Referral Patterns for Adolescent and Young Adult Patients with Cancer in Utah. J Adolesc Young Adult Oncol 2018; 7:688-691. [PMID: 30036101 DOI: 10.1089/jayao.2018.0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cancer therapy is selected by individual oncology providers. For adolescent and young adults (AYAs), the type of provider, adult or pediatric, and medical facility type, non- or academic, influence regimens offered. We evaluated the proportions of 15-29-year-old cancer patients in Utah seen at pediatric and adult academic centers between 1994 and 2013 and examined factors that influence treatment location. Of all AYA patients, 31.6% were treated in academic centers and those with sarcomas, central nervous system tumors, and leukemias were more likely to be treated at academic centers. Further determinants of AYA healthcare access and cooperation between adult and pediatric providers are needed.
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Affiliation(s)
- Holly Spraker-Perlman
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rochelle R Smits-Seeman
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Hongyan Li
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.,Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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11
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Martins HTG, Balmant NV, de Paula Silva N, Santos MDO, Reis RDS, de Camargo B. Who cares for adolescents and young adults with cancer in Brazil? J Pediatr (Rio J) 2018; 94:440-445. [PMID: 28888615 DOI: 10.1016/j.jped.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/29/2017] [Accepted: 06/14/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Approximately 6% of all cancers arise in adolescents and young adults. Currently, the ward type best placed to treat this patient group remains controversial. The aim of this study was to evaluate exactly where adolescents and young adults with cancer are treated in Brazil. METHODS Data were extracted from 271 Brazilian hospital-based cancer registries (2007-2011), including all five national regions (North, Northeast, Midwest, South, and Southeast). Variables included gender, age, ethnicity, National Code of Health Establishment, hospital unit state, and region. Tumors were classified according to the World Health Organization classification for adolescents and young adults with cancer. Odds ratios with 95% confidence intervals were computed by unconditional logistic regression. RESULTS Most patients were managed on medical oncology wards, followed by pediatric oncology and then by non-specialist wards. Of patients aged 15-19 years, 49% were managed on pediatric wards; most of the older patients (96%; aged 20-24) were managed on adult wards. Patients were more likely to be seen in medical oncology wards as their age increased (OR=2.03 [1.98-2.09]), or if they were based in the South (OR=1.50 [1.29-1.73]). Conversely, bone tumors were less likely to be treated (decreased OR) on medical oncology wards, regardless of age, gender, and region. CONCLUSION An elevated risk of treatment on medical oncology wards was observed for older patients and those treated in the South. Bone tumors were generally treated in pediatric oncology wards, while skin cancers were treated in medical oncology wards, regardless of age, gender, and region.
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Affiliation(s)
- Helena T G Martins
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Câncer, Centro de Pesquisa, Programa de Hematologia Pediátrica e Oncologia, Rio de Janeiro, RJ, Brazil
| | - Nathalie V Balmant
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Câncer, Centro de Pesquisa, Programa de Hematologia Pediátrica e Oncologia, Rio de Janeiro, RJ, Brazil
| | - Neimar de Paula Silva
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Câncer, Centro de Pesquisa, Programa de Hematologia Pediátrica e Oncologia, Rio de Janeiro, RJ, Brazil
| | - Marceli de O Santos
- Instituto Nacional do Câncer, Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz de Camargo
- Instituto Nacional de Câncer, Centro de Pesquisa, Programa de Hematologia Pediátrica e Oncologia, Rio de Janeiro, RJ, Brazil.
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Who cares for adolescents and young adults with cancer in Brazil? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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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Gordon LM, Johnson RH, Au MA, Langer SL, Albritton KH. Primary Care Physicians' Decision Making Regarding Initial Oncology Referral for Adolescents and Young Adults With Cancer. J Adolesc Health 2018; 62:176-183. [PMID: 29248393 DOI: 10.1016/j.jadohealth.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objectives of this study were to determine whether pediatricians are more likely than other primary care physicians (PCPs) to refer newly diagnosed adolescent and young adult patients with cancer to pediatric oncological specialists, and to assess the physician and patient characteristics that affect patterns of referral. METHODS A cross-sectional vignette survey was mailed to PCPs to examine hypothetical referral decisions as a function of physician characteristics and patient characteristics, including diagnosis, age, gender, race/ethnicity, family support, transportation, insurance, and patient preference for site of care. Pediatrician PCPs and nonpediatrician PCPs (family medicine, internal medicine, and emergency medicine physicians) practicing in North Carolina and in Washington State participated in the study. RESULTS A total of 406 surveys were completed (35.8% response rate). Sixty percent of pediatric PCPs referred their hypothetical patients with cancer to pediatric specialists (PSs), compared with only 37% of nonpediatric PCPs. Patient age also influenced referral patterns; 89% of 13-year-olds, 74% of 16-year-olds, 25% of 19-year-olds, and only 9% of 22-year-old patients were referred to a PS. Multivariate logistic regression demonstrated that diagnosis and physician practice setting also were associated with referral patterns. CONCLUSIONS Both patient age and PCP specialty were significant predictors of referral patterns in hypothetical vignettes of newly diagnosed adolescent and young adult patients with cancer. Pediatricians were more likely than nonpediatrician PCPs to refer patients to a PS. Referrals to PSs decreased dramatically between ages 16 and 19. Because the site of oncological care can impact outcomes, these data have the potential to inform awareness and education initiatives directed at PCPs.
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Affiliation(s)
- Lynne M Gordon
- Department of Public Health, University of Washington, Seattle, Washington
| | - Rebecca H Johnson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Margaret A Au
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Shelby L Langer
- School of Social Work, University of Washington, Seattle, Washington
| | - Karen H Albritton
- Departments of Medical and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Parzuchowski A, Bush R, Pei Q, Friedman DL, FitzGerald TJ, Wolden SL, Dharmarajan KV, Constine LS, Laurie F, Kessel SK, Appel B, Fernandez K, Punnett A, Schwartz CL, Cox J, Terezakis SA. Patterns of Involved-Field Radiation Therapy Protocol Deviations in Pediatric Versus Adolescent and Young Adults With Hodgkin Lymphoma: A Report From the Children's Oncology Group AHOD0031. Int J Radiat Oncol Biol Phys 2018; 100:1119-1125. [PMID: 29722656 DOI: 10.1016/j.ijrobp.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/27/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The presented protocol for pediatric intermediate-risk Hodgkin lymphoma evaluated the use of a dose-intensive chemotherapy regimen (ABVE-PC [doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, prednisone]) with response-based therapy augmentation (addition of DECA [dexamethasone, etoposide, cisplatin, cytarabine]) or therapy reduction (elimination of radiation). METHODS AND MATERIALS A central review of the radiation therapy data for quality assurance was performed, and the association between radiation protocol deviation (RPD) and relapse was assessed in the pediatric group (age <15 years) and adolescent and young adult (AYA) group (age ≥15-21 years). Involved-field radiation therapy (IFRT) planning was reviewed before the start of treatment and at treatment completion. The records were reviewed through the Quality Assurance Review Center's central review to identify RPD, classified according to dose deviation (DD), volume deviation (VD), undertreatment (UT), and overtreatment (OT). DDs and VDs were further classified as major or minor. RESULTS Of the 1712 patients enrolled, 1155 received IFRT, of whom, 216 (18.7%) had RPDs. The DD and VD patterns were similar between the pediatric and AYA groups. Minor VDs were most common. UT RPDs accounted for 69% in the pediatric group and 75% in the AYA group. Of the 35 patients with relapse and a RPD, 29 had an undertreatment RPD. Among the patients who received IFRT, a significant difference was found in the cumulative incidence rates of relapse between the pediatric and AYA groups (P = .03); however, no significant difference was found between patients with and without RPD (P = .2). CONCLUSIONS Most RPDs were minor and consisted of UT in the AYA and pediatric populations both. No difference was observed in RPDs between the pediatric and AYA patients. Thus, in a well-defined and standardized protocol, the RPD distributions for AYA patients will be similar to those for pediatric population. However, the increased cumulative incidence of relapse in the AYA patients who had received IFRT compared with the pediatric population requires further exploration, given the potential differences in clinical outcomes in the AYA population.
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Affiliation(s)
- Aaron Parzuchowski
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rizvan Bush
- Children's Oncology Group, Monrovia, California
| | - Qinglin Pei
- Children's Oncology Group, University of Florida, Gainesville, Florida
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Thomas J FitzGerald
- Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Fran Laurie
- Quality Assurance Review Center, Lincoln, Rhode Island
| | | | - Burton Appel
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Karen Fernandez
- Department of Oncology, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Angela Punnett
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cindy L Schwartz
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, Texas
| | - Jacob Cox
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ballantine KR, Watson H, Macfarlane S, Winstanley M, Corbett RP, Spearing R, Stevanovic V, Yi M, Sullivan MJ. Small Numbers, Big Challenges: Adolescent and Young Adult Cancer Incidence and Survival in New Zealand. J Adolesc Young Adult Oncol 2017; 6:277-285. [DOI: 10.1089/jayao.2016.0074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kirsten R. Ballantine
- National Child Cancer Network NZ, Auckland, New Zealand
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Heidi Watson
- AYA Cancer Network Aotearoa, Auckland, New Zealand
| | - Scott Macfarlane
- National Child Cancer Network NZ, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Mark Winstanley
- Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Robin P. Corbett
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Ruth Spearing
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
| | - Vladimir Stevanovic
- Health and Disability Intelligence, New Zealand Ministry of Health, Wellington, New Zealand
| | - Ma Yi
- Canterbury District Health Board, Christchurch, New Zealand
| | - Michael J. Sullivan
- Children's Cancer Research Group, University of Otago, Christchurch, New Zealand
- Children's Cancer Centre, The Royal Children's Hospital, Melbourne, Australia
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Desandes E, Brugieres L, Laurence V, Berger C, Kanold J, Tron I, Clavel J, Lacour B. Survival of adolescents with cancer treated at pediatric versus adult oncology treatment centers in France. Pediatr Blood Cancer 2017; 64. [PMID: 27860291 DOI: 10.1002/pbc.26326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND In France, although children aged less than 15 years with cancer are usually referred to pediatric oncology centers, adolescents may be treated at pediatric or adult oncology centers. The objective was to compare survival according to their site of treatment. PROCEDURE Using population-based registration, 15- to 19-year-old patients diagnosed with cancer in 2006 or 2007 and living in six French regions (accounting for 41% of the French population) were included. RESULTS Of the 594 patients included, 33% of the French adolescents were treated at a pediatric oncology center. Compared with those treated at a pediatric center, adolescents treated at an adult center were older, were more likely to have carcinoma and germ-cell tumor, had a longer time to diagnosis, and were less likely to be enrolled in a clinical trial. In addition, the decisions for their management were less likely to be taken in the context of multidisciplinary team meetings. In multivariate analysis, adolescent patients treated at a pediatric center did not have significantly different overall survival (OS) compared with those treated at an adult center (5-year OS: 84.1% [95% confidence interval: 78.6-90.0] versus 87.7% [95% confidence interval: 84.2-91.3]; P = 0.25). CONCLUSIONS The outcomes of French adolescents with cancer have begun to improve, with 81.2% survival in 2006-2007, with no difference between the types of treatment center. However, for this unique group of diseases, survival is not the unique endpoint. In order to ensure good quality of life after cancer, management of those patients requires specific approaches, designed to reduce the late effects of cancer treatment and improve supportive care.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
| | - Laurence Brugieres
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | | | - Claire Berger
- Rhône-Alpes Childhood Cancer Registry, University Hospital Centre of St-Etienne, St-Etienne, France
| | - Justyna Kanold
- Childhood Cancer Registry of Auvergne/Limousin, Inserm CIC 501, University Hospital Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Tron
- Childhood Cancer Registry of Bretagne, ORS Rennes, Rennes, France
| | - Jacqueline Clavel
- Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France.,French National Registry of Childhood Cancer-French National Registry of Childhood Hematological Malignancies, Villejuif, France
| | - Brigitte Lacour
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
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de Oliveira C, Bremner KE, Liu N, Greenberg ML, Nathan PC, McBride ML, Krahn MD. Costs for Childhood and Adolescent Cancer, 90 Days Prediagnosis and 1 Year Postdiagnosis: A Population-Based Study in Ontario, Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:345-356. [PMID: 28292479 DOI: 10.1016/j.jval.2016.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Childhood and adolescent cancers are uncommon, but they have important economic and health impacts on patients, families, and health care systems. Few studies have measured the economic burden of care for childhood and adolescent cancers. OBJECTIVES To estimate costs of cancer care in population-based cohorts of children and adolescents from the public payer perspective. METHODS We identified patients with cancer, aged 91 days to 19 years, diagnosed from 1995 to 2009 using cancer registry data, and matched each to three noncancer controls. Using linked administrative health care records, we estimated total and net resource-specific costs (in 2012 Canadian dollars) during 90 days prediagnosis and 1 year postdiagnosis. RESULTS Children (≤14 years old) numbered 4,396: 36% had leukemia, 21% central nervous system tumors, 10% lymphoma, and 33% other cancers. Adolescents (15-19 years old) numbered 2,329: 28.9% had lymphoma. Bone and soft tissue sarcoma, germ cell tumor, and thyroid carcinoma each comprised 12% to 13%. Mean net prediagnosis costs were $5,810 and $1,127 and mean net postdiagnosis costs were $136,413 and $62,326 for children and adolescents, respectively; the highest were for leukemia ($157,764 for children and $172,034 for adolescents). In both cohorts, costs were much higher for patients who died within 1 year of diagnosis. Inpatient hospitalization represented 69% to 74% of postdiagnosis costs. CONCLUSIONS Treating children with cancer is costly, more costly than treating adolescents or adults. Substantial survival gains in children mean that treatment may still be very cost-effective. Comprehensive age-specific population-based cost estimates are essential to reliably assess the cost-effectiveness of cancer care for children and adolescents, and measure health system performance.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark L Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Chevreau C, Gladieff L, Faure-Conter C. [Germ cell tumor in adolescents and young adults]. Bull Cancer 2016; 103:1057-1063. [PMID: 27823808 DOI: 10.1016/j.bulcan.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Abstract
Management of extracranial germ cell tumors (TG) is emblematic of the adolescents and young adults' problematic. Beyond persisting differences in care between adult and pediatric oncologists, it emphasizes the need for effective collaboration between both teams. If the therapy is primarily guided today by adult standards, pediatricians bring expertise in long-term follow-up, justified by the increasing description of late side effects in this young population, with highly curable disease since cisplatin's emergence.
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Affiliation(s)
- Christine Chevreau
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Laurence Gladieff
- Institut Claudius-Regaud, IUCT-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Cécile Faure-Conter
- Institut d'hémato-oncologie pédiatrique, 1, place J.-Renaud, 69008 Lyon, France.
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Parsons HM, Harlan LC, Schmidt S, Keegan THM, Lynch CF, Kent EE, Wu XC, Schwartz SM, Chu RL, Keel G, Smith AW. Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study. J Adolesc Young Adult Oncol 2016; 4:141-50. [PMID: 26421222 DOI: 10.1089/jayao.2014.0041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Physicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited. METHODS Using the National Cancer Institute's population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests. RESULTS Treating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01). CONCLUSIONS Most AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.
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Affiliation(s)
- Helen M Parsons
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas
| | - Linda C Harlan
- Applied Research Program, National Cancer Institute , Bethesda, Maryland
| | - Susanne Schmidt
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas
| | | | - Charles F Lynch
- Department of Epidemiology, University of Iowa , Iowa City, Iowa
| | - Erin E Kent
- Applied Research Program, National Cancer Institute , Bethesda, Maryland
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Louisiana State University Health Sciences Center , New Orleans, Louisiana
| | - Stephen M Schwartz
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Roland L Chu
- Department of Pediatrics, Wayne State University , Detroit, Michigan
| | - Gretchen Keel
- Information Management Services , Calverton, Maryland
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Sawyer SM, McCarthy MC, Dunt D, McNeil R, Thompson K, Orme L, Drew SE. Fulfilling the Vision of Youth-Friendly Cancer Care: A Study Protocol. J Adolesc Young Adult Oncol 2016; 5:267-77. [DOI: 10.1089/jayao.2015.0050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susan M. Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Maria C. McCarthy
- Murdoch Childrens Research Institute, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Sarah E. Drew
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
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Smith AW, Seibel NL, Lewis DR, Albritton KH, Blair DF, Blanke CD, Bleyer WA, Freyer DR, Geiger AM, Hayes-Lattin B, Tricoli JV, Wagner LI, Zebrack BJ. Next steps for adolescent and young adult oncology workshop: An update on progress and recommendations for the future. Cancer 2016; 122:988-99. [PMID: 26849003 DOI: 10.1002/cncr.29870] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Abstract
Each year, 70,000 adolescents and young adults (AYAs) between ages 15 and 39 years in the United States are diagnosed with cancer. In 2006, a National Cancer Institute (NCI) Progress Review Group (PRG) examined the state of science associated with cancer among AYAs. To assess the impact of the PRG and examine the current state of AYA oncology research, the NCI, with support from the LIVESTRONG Foundation, sponsored a workshop entitled "Next Steps in Adolescent and Young Adult Oncology" on September 16 and 17, 2013, in Bethesda, Maryland. This report summarizes the findings from the workshop, opportunities to leverage existing data, and suggestions for future research priorities. Multidisciplinary teams that include basic scientists, epidemiologists, trialists, biostatisticians, clinicians, behavioral scientists, and health services researchers will be essential for future advances for AYAs with cancer.
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Affiliation(s)
- Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Denise R Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Karen H Albritton
- Cook Children's Medical Center and University of North Texas Health Science Center, Houston, Texas
| | - Donald F Blair
- Division of Cancer Biology, National Cancer Institute, Bethesda, Maryland
| | - Charles D Blanke
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - W Archie Bleyer
- Radiation Medicine Department, Oregon Health and Science University, Portland, Oregon
| | - David R Freyer
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Stark D, Bielack S, Brugieres L, Dirksen U, Duarte X, Dunn S, Erdelyi D, Grew T, Hjorth L, Jazbec J, Kabickova E, Konsoulova A, Kowalczyk J, Lassaletta A, Laurence V, Lewis I, Monrabal A, Morgan S, Mountzios G, Olsen P, Renard M, Saeter G, van der Graaf W, Ferrari A. Teenagers and young adults with cancer in Europe: from national programmes to a European integrated coordinated project. Eur J Cancer Care (Engl) 2015; 25:419-27. [DOI: 10.1111/ecc.12365] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Affiliation(s)
- D. Stark
- Leeds Institute of Cancer and Pathology; Leeds Institute of Oncology and St James's University Hospital; University of Leeds; Leeds UK
| | - S. Bielack
- Klinikum Stuttgart; Center for Pediatric and Adolescent Medicine; Pediatrics 5 (Oncology, Hematology, Immunology); Olgahospital; Stuttgart Germany
| | - L. Brugieres
- Department of Children and Adolescents Oncology; Institut Gustave Roussy; Villejuif France
| | - U. Dirksen
- University Hospital Muenster; Department of Pediatric Hematology and Oncology; Westfalian Wilhelms University; Muenster Germany
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - X. Duarte
- Instituto Português de Oncologia de Lisboa; Lisbon Portugal
| | - S. Dunn
- Teenage Cancer Trust; London UK
| | | | - T. Grew
- Oxford University Clinical Academic Graduate School; Oxford UK
| | - L. Hjorth
- Department of Pediatrics; Skåne University Hospital; Clinical Sciences Lund University; Lund Sweden
| | - J. Jazbec
- Division of Pediatrics; Unit of Hematooncology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | | | | | - J.R. Kowalczyk
- Children's University Hospital; Skubiszewski Medical University of Lublin; Lublin Poland
| | - A. Lassaletta
- Hospital Infantil Universitario Niño Jesús; Madrid Spain
| | - V. Laurence
- Department of Medical and Pediatric Oncology; Institut Curie; Paris France
| | - I. Lewis
- Alder Hey Children's NHS Foundation Trust; Liverpool
| | - A. Monrabal
- Spanish Association of Adolescents and Young Adult with Cancer; London
| | - S. Morgan
- Teenage Cancer Trust Unit; St James's University Hospital; Leeds UK
| | - G. Mountzios
- University of Athens School of Medicine; Athens Greece
| | - P.R. Olsen
- Department of Oncology; Aarhus University Hospital; Aarhus C Denmark
| | - M. Renard
- Department of Pediatric Hemato-Oncology; University Hospitals Leuven; Leuven Belgium
| | - G. Saeter
- Institute for Cancer Research; Oslo University Hospital; Oslo Norway
| | - W.T. van der Graaf
- Department of Medical Oncology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A. Ferrari
- Pediatric Oncology Unit; Fondazione IRCCS Istituto Nazionale Tumori; Milan Italy
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Baxter NN, Daly C, Gupta S, Pole JD, Sutradhar R, Greenberg ML, Nathan PC. The Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy (IMPACT) Cohort Study: a population-based cohort of young Canadians with cancer. BMC Cancer 2014; 14:805. [PMID: 25367402 PMCID: PMC4228075 DOI: 10.1186/1471-2407-14-805] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/21/2014] [Indexed: 12/02/2022] Open
Abstract
Background Cancer is the leading cause of disease-related death in adolescents and young adults (AYA). Annual improvements in AYA cancer survival have been inferior to those observed in children and older adults. Prior studies of AYA with cancer have been limited by their focus on patients from select treatment centres, reducing generalizability, or by being population-based but lacking diagnostic and treatment details. There is a critical need to conduct population-based studies that capture detailed patient, disease, treatment and system-level data on all AYA regardless of treatment location. Methods/Design We will create a cohort of all AYA (aged 15–21 years) at the time of diagnosis with any malignancy between 1992 and 2011 in Ontario, Canada (n = 5,394). Subjects will be identified through the Ontario Cancer Registry and the final cohort will be expanded to include 2012 diagnoses, as these data become available. Detailed diagnostic, treatment and outcome data for those patients treated at a pediatric cancer centre will be provided by a population-based pediatric cancer registry (n = 1,030). For 15–18 year olds treated at adult centres (n = 923) and all 19–21 year olds (n = 3396), trained abstractors will collect the comparable data elements from medical records. We will link these data to population-based administrative health data that include physician billings, hospitalizations and emergency room visits. This will allow descriptions of health care access and use prior to cancer diagnosis, and during and after treatment. Discussion The IMPACT cohort will serve as a platform for addressing questions that span the AYA cancer journey. These will include determining which factors influence where AYA receive care, the impact of locus of care on the types and intensity of cancer therapy, appropriateness of surveillance for disease recurrence, access to clinical trials, and receipt of palliative and survivor care. Findings using the IMPACT cohort have the potential to lead to changes in practice and cancer policy, reduce mortality, and improve quality of life for AYA with cancer. The IMPACT data platform will be a permanent resource, accessible to researchers across Canada.
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Affiliation(s)
- Nancy N Baxter
- Department of Surgery, St, Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
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Place AE, Frederick NN, Sallan SE. Therapeutic approaches to haematological malignancies in adolescents and young adults. Br J Haematol 2013; 164:3-14. [PMID: 24007213 DOI: 10.1111/bjh.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
Tremendous strides have been made in improving the outcomes of haematological malignancies (HM) over the last three decades, but adolescents and young adult (AYA) patients have not benefitted equally compared to younger and older patients. Excellent outcomes in Hodgkin lymphoma have allowed tailoring of highly effective regimens that limit the incidence of late effects. Early successes in paediatric acute lymphoblastic leukaemia set the stage for a series of studies in young adults utilizing a paediatric-type treatment strategy. These studies have determined that AYAs benefit from paediatric-type chemotherapy regimens. Despite the increased incidence of acute myeloid leukaemia and non-Hodgkin lymphoma in the AYA age group, optimal strategies for these patients have not been systematically pursued. There is renewed interest in improving HM outcomes in AYA patients and this will rely on the development of clinical trials that specifically target these patients. Understanding and addressing the unique psychosocial challenges of this population will be critical in supporting this endeavor.
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Affiliation(s)
- Andrew E Place
- Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Ferrari A. The Challenge of Access to Care for Adolescents with Cancer in Italy: National and Local Pediatric Oncology Programs. International Perspectives on AYAO, Part 2. J Adolesc Young Adult Oncol 2013; 2:112-7. [DOI: 10.1089/jayao.2012.0013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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28
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Ferrari A, Bisogno G, Meazza C, Vajna de Pava M, Sultan I, De Salvo GL, Clerici CA, Veneroni L, Casanova M. The challenge of access to care for soft tissue sarcomas bridging pediatric and adult age: the Italian pediatric oncology view. Expert Rev Anticancer Ther 2012; 12:243-54. [PMID: 22316372 DOI: 10.1586/era.11.209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Synovial sarcoma and rhabdomyosarcoma are two high-grade soft tissue sarcoma subtypes that occur in adolescents and young adults. Managing these malignancies in patients in this age bracket poses various clinical problems, partly because different therapeutic approaches are sometimes adopted by pediatric and adult oncologists, even though they are dealing with the same condition. In this review, the doubts concerning how best to manage soft tissue sarcomas in patients between pediatric and adult ages lead up to a more general discussion of the issue of access to optimal cancer services for adolescents and young adults - a subset of patients acknowledged as being under-represented in clinical trials on therapies that may improve their outcome. The situation in Italy is described, along with action taken in an effort to bridge the gap and implement specific programs tailored to these patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori Via G Venezian, Milan 1-20133, Italy.
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O'Brien SH, Klima J, Termuhlen AM, Kelleher KJ. Venous thromboembolism and adolescent and young adult oncology inpatients in US children's hospitals, 2001 to 2008. J Pediatr 2011; 159:133-7. [PMID: 21353248 DOI: 10.1016/j.jpeds.2011.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 11/04/2010] [Accepted: 01/06/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the frequency of venous thromboembolism (VTE) in the adolescent and young adult oncology population and the effects of age and cancer type on VTE, and to characterize adolescent and young adult oncology admissions at US children's hospitals. STUDY DESIGN We extracted data on oncology patients 15 to 24 years of age who were discharged from 35 hospitals in the Pediatric Hospital Information System (PHIS) between 2001 and 2008. RESULTS Of 9721 unique patients, VTE occurred in 511 (5.3%). An elevated OR of VTE occurred in patients 18 to 20 and 21 to 24 years of age (OR, 1.65; 95% CI, 1.36-2.00 and OR, 1.67; 95% CI, 1.21-2.32, respectively) compared with that in patients 15 to 17 years old. Patients with leukemia (OR, 5.53; 95% CI, 3.63-8.42) and bone/soft tissue sarcomas (OR, 4.32; 95% CI, 2.80-6.69) had a higher risk of VTE compared with patients with brain tumors. The number of adolescent and young adult oncology admissions to pediatric hospitals increased 31.9%, from 5409 admissions in 2001 to 7134 admissions in 2008. CONCLUSIONS Adolescent and young adult oncology patients, a growing population at pediatric hospitals, experience VTE as a common complication. Pediatricians should implement adolescent and young adult-specific studies to develop a standardized approach to preventing this adverse event.
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Affiliation(s)
- Sarah H O'Brien
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
Cancer in adolescents and young adults is an important public health issue, because there are approximately 1 million new cases annually. The distribution of diseases in this age group varies geographically, contributing to differences in survival rates. Although an overall survival rate exceeding 80 % has been reported in optimal circumstances, emerging knowledge about distinctions in tumor biology and enhanced clinical accrual to clinical trials should lead to further gains. The challenges of cancer survivorship demand further attention with a particular focus on the quality of life of survivors and amelioration of the long-term complications of treatment. Programs in cancer screening and prevention provide potential for considerable benefits in this age group. A renewed perspective on the adolescent and young adult cohort is required; and, in all of these opportunities for change, there are important roles to be played by advocacy groups internationally.
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Affiliation(s)
- Ronald D Barr
- Pediatric Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada.
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31
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Greenberg M, Klassen A, Gafni A, McBride ML, Albritton K. Outcomes and metrics: measuring the impact of a comprehensive adolescent and young adult cancer program. Cancer 2011; 117:2342-50. [PMID: 21523756 DOI: 10.1002/cncr.26040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Against a background of poorly coordinated provision of holistic care to the adolescent and young adult (AYA) cancer population, the Canadian National Task Force on Adolescent and Young Adult Oncology, which is supported by the Canadian Partnership Against Cancer and the C17 network, convened a workshop to formulate the components of a systematic approach to care for this age group. Because such a program will deflect scarce resources, it must be validated and justified by reproducible metrics. A subgroup of experts was convened, comprising attendees at the AYA workshop, including AYA cancer survivors. A substantial number of key, feasible, and consistent metrics were identified and are systematized, justified, and presented in this article. Prioritization from within this range will be necessary.
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Affiliation(s)
- Mark Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
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Ramphal R, Meyer R, Schacter B, Rogers P, Pinkerton R. Active therapy and models of care for adolescents and young adults with cancer. Cancer 2011; 117:2316-22. [DOI: 10.1002/cncr.26048] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
Adolescents and young adults (AYA) with cancer have been designated as a vulnerable population by the National Cancer Institute. This group, defined by the ages of 16-39 years, has not enjoyed the same survival improvements over the past several decades as older and younger cohorts. Several barriers prevent the optimal delivery of oncologic care in this subpopulation. This review will describe these challenges in the context of the major hematologic malignancies affecting this population (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], Hodgkin lymphoma [HL], and non-Hodgkin lymphoma [NHL]). For example, historical differences in care delivery between pediatric and adult health care systems have created confusion about optimal treatment planning for AYAs, a population that spans the pediatric-adult divide. In the case of ALL, retrospective studies have demonstrated significantly better outcomes when AYAs are treated according to pediatric and not adult protocols. Additional challenges more specific to AYAs include increased treatment-related toxicity relative to younger patients; less access to care and, specifically, access to clinical trials; lower adherence to medications and treatment plans; and psychosocial stressors relevant to individuals at this stage of life. Recognizing and responding to these challenges in AYAs may create opportunities to improve the cancer outcomes of this group.
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Kieran MW, Walker D, Frappaz D, Prados M. Brain Tumors: From Childhood Through Adolescence Into Adulthood. J Clin Oncol 2010; 28:4783-9. [DOI: 10.1200/jco.2010.28.3481] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The transition from childhood to adulthood through adolescence has been clearly identified as a time of great physical, psychological, emotional, social, and sexual change. Clinical care is currently divided into adult or pediatric care; adolescent patients require specific expertise that most clinical practices do not have. When illness coincides with the adolescent transition, the health system is severely challenged. Health systems historically have varied widely in the age they choose for allocating an individual to the adult model of health care. Tumors of the CNS complicate the difficult adjustments required in adolescents and young adults by virtue of their morbidity, complex treatment, and prognosis. Some brain tumors are unique to children, some occur predominantly in adults, and others peak in adolescence. Delays in the diagnosis of brain tumors can occur at any age but are particularly common in adolescence because of difficulties of accessing health systems, the difficulties of discriminating pathologic from typical adolescent behavioral characteristics, and changing endocrine function. Coming to terms with the cancer diagnosis; coping personally, socially, and financially with cancer treatments; accepting the risk of a shortened life span; confronting acquired disability; and coping with complex rehabilitation and adjusted plans for life are challenges for which there are no established specialist health models. This article will discuss the changing brain tumor profile of children, adolescents, and adults, with a focus on our limited understanding of the adolescent/young adult transition period.
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Affiliation(s)
- Mark W. Kieran
- From the Dana-Farber Cancer Institute, Boston, MA; Queen's Medical Center, School of Human Development, Nottingham, United Kingdom; Institut d'Hémato-Oncologie Pédiatrique, Lyon, France; and Brain Tumor Research Center, University of California, San Francisco, CA
| | - David Walker
- From the Dana-Farber Cancer Institute, Boston, MA; Queen's Medical Center, School of Human Development, Nottingham, United Kingdom; Institut d'Hémato-Oncologie Pédiatrique, Lyon, France; and Brain Tumor Research Center, University of California, San Francisco, CA
| | - Didier Frappaz
- From the Dana-Farber Cancer Institute, Boston, MA; Queen's Medical Center, School of Human Development, Nottingham, United Kingdom; Institut d'Hémato-Oncologie Pédiatrique, Lyon, France; and Brain Tumor Research Center, University of California, San Francisco, CA
| | - Michael Prados
- From the Dana-Farber Cancer Institute, Boston, MA; Queen's Medical Center, School of Human Development, Nottingham, United Kingdom; Institut d'Hémato-Oncologie Pédiatrique, Lyon, France; and Brain Tumor Research Center, University of California, San Francisco, CA
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Potential Favorable Impact of the Affordable Care Act of 2010 on Cancer in Young Adults in the United States. Cancer J 2010; 16:563-71. [DOI: 10.1097/ppo.0b013e3181ff6509] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Dancey JE. From Quality of Publication to Quality of Care: Translating Trials to Practice. J Natl Cancer Inst 2010; 102:670-1. [DOI: 10.1093/jnci/djq142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Subbiah V. Adolescent oncology: who cares?-the new KID on the block. Support Care Cancer 2010; 18:771-3. [PMID: 20383720 DOI: 10.1007/s00520-010-0861-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 03/01/2010] [Indexed: 11/26/2022]
Abstract
The paper reports a case of a 25-year-old male with a new diagnosis of acute lymphoblastic leukemia admitted in a predominantly older adult cancer ward. It explores the emerging area of adolescent oncology. Despite the advances of modern cancer medicine in both survival and outcomes, these adolescent and young adult cancer patients are an underserved group. Their medical, physical, psychological, and emotional needs are different and ought to be managed differently, just like pediatric or geriatric subpopulations. Cancer adds an enormous burden to the already turbulent period of adolescence. Cancer incidence in the 15-29-year age group is at least three times than that of those younger than 15 years of age, and it kills more young adults than any disease except depression-induced suicide. The need for optimizing and personalizing care in this age group is highlighted.
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Affiliation(s)
- Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 87, Houston, TX 77030, USA,
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