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Ferrari A, Perillo T, Milano GM, Silva M, Rutigliano C, Salvo A, Livellara V, Conte M, Coccoli L, Amore E, Pierobon M, Vietina F, Pagani Bagliacca E, Spinelli M, Massei MS, Massetti V, Legnani E, Puglisi I, Zucchetti G, Quarello P. The power of art and the powers of adolescents with cancer: Age-specific projects at Italian pediatric oncology centers. TUMORI JOURNAL 2024; 110:218-226. [PMID: 38591573 DOI: 10.1177/03008916241245005] [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: 04/10/2024]
Abstract
This article describes the oncology programs developed in Italy for adolescents and young adults with cancer, with a specific focus on the local projects created in pediatric oncology centers. A common feature of such projects is the emphasis on creative and artistic activities and laboratories (involving music, photography, novel writing, fashion design, and so on) designed to give young patients innovative means of expression.This article highlights the amazing powers of adolescents involved in these projects: the power to produce beautiful things in a place that is not normally associated with the idea of beauty; the power to make their doctors smile and grasp the profound sense of life; the power to make hospitals become places for producing culture.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Teresa Perillo
- Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy
| | | | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Rutigliano
- Pediatric Hematology-Oncology Division, Department of Pediatrics, University of Bari, Bari, Italy
| | - Andrea Salvo
- Hematology/Oncology, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
| | - Virginia Livellara
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Massimo Conte
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Luca Coccoli
- Pediatric Hematology-Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Elena Amore
- Pediatric Hematology-Oncology Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marta Pierobon
- Pediatric Hematology Oncology Division, University of Padua, Padua, Italy
| | - Francesco Vietina
- Pediatric Hematology Oncology Division, University of Padua, Padua, Italy
| | - Elena Pagani Bagliacca
- Pediatric Hematology-Oncology Department, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Marco Spinelli
- Pediatric Hematology-Oncology Department, Fondazione MBBM, Ospedale San Gerardo, Monza, Italy
| | - Maria Speranza Massei
- Pediatric Oncology-Hematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Massetti
- Pediatric Oncology-Hematology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Elena Legnani
- Hematology-Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ilaria Puglisi
- Hematology-Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Zucchetti
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
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Molina-Prado A, Pérez de Albéniz A, Medin G, Pérez-Alonso V, Carceller E, Huguet-Rodríguez B, Garrido-Colino C. Spanish adolescent patients with cancer and main caregivers: Using perceptions of care to drive change in healthcare. J Healthc Qual Res 2024:S2603-6479(24)00060-5. [PMID: 39043525 DOI: 10.1016/j.jhqr.2024.07.002] [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: 12/11/2023] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To determine whether there are differences in care experience of adolescent cancer patients and their main caregiver, treated in Adolescent Cancer Units (ACUs), compared to those treated in Non-Adolescent Cancer Units (NACUs), including the COVID-19 pandemic period. METHOD Measurement of Reported Experience in adolescent oncology patients (12-19 years old) and caregivers through ad hoc surveys. The responses of the study group of patients and caregivers treated in Adolescent Units were compared with the group not treated in them. RESULTS It is noted that many respondents consider that they have not been affected by the COVID-19 pandemic. Significant differences were seen in communication, with better perception by the group of patients treated in ACU (87.1%) and caregivers of ACU (97.3%) compared to patients and caregivers of NACU (53.3% and 68.2% respectively). Regarding information received about the side effects, a better perception was observed among patients treated in the ACU than in the NACU (p=0.247). In the transmission of information and the possibility of fertility preservation, a significant difference was observed in favour of ACU in patients and direct caregivers (p=0.010 and p=0.018). CONCLUSIONS ACU represents an improvement in the quality perceived by patients and main caregiver on key points in the comprehensive care of the adolescent with cancer such as information, participation in the process and decision making, approach to side effects, psychological care and help in returning to normal life. However, fertility and strategies for talking about the cancer experience, were identified as areas for future improvement.
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Affiliation(s)
- A Molina-Prado
- Facultad de Medicina, Universidad Complutense Madrid, Spain
| | | | - G Medin
- Adolescent Cancer Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Pérez-Alonso
- Adolescent Cancer Unit, Hospital Doce de Octubre, Madrid, Spain
| | - E Carceller
- Adolescent Cancer Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - B Huguet-Rodríguez
- Adolescent Cancer Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Garrido-Colino
- Adolescent Cancer Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
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Hayes AJ, Nixon IF, Strauss DC, Seddon BM, Desai A, Benson C, Judson IR, Dangoor A. UK guidelines for the management of soft tissue sarcomas. Br J Cancer 2024:10.1038/s41416-024-02674-y. [PMID: 38734790 DOI: 10.1038/s41416-024-02674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location, means that developing evidence-based guidelines is complicated by the limitations of the data available. This makes it more important that STS are managed by expert multidisciplinary teams, to ensure consistent and optimal treatment, recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous versions published in 2010 and 2016 [1, 2]. The original guidelines were drawn up by a panel of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This iteration of the guidance, as well as updating the general multidisciplinary management of soft tissue sarcoma, includes specific sections relating to the management of sarcomas at defined anatomical sites: gynaecological sarcomas, retroperitoneal sarcomas, breast sarcomas, and skin sarcomas. These are generally managed collaboratively by site specific multidisciplinary teams linked to the regional sarcoma specialist team, as stipulated in the recently published sarcoma service specification [3]. In the UK, any patient with a suspected soft tissue sarcoma should be referred to a specialist regional soft tissues sarcoma service, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging and a tissue biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon, combined with pre- or post-operative radiotherapy for tumours at higher risk for local recurrence. Systemic anti-cancer therapy (SACT) may be utilised in cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late effects of treatment.
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Affiliation(s)
- Andrew J Hayes
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Ioanna F Nixon
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Center, Glasgow, G12 0YN, UK
| | - Dirk C Strauss
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Beatrice M Seddon
- Department of Medical Oncology, University College London Hospital NHS Foundation Trust, London, NW1 2BU, UK
| | - Anant Desai
- The Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Charlotte Benson
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Ian R Judson
- The Institute of Cancer Research, London, SM2 5NG, UK
| | - Adam Dangoor
- Department of Medical Oncology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, BS1 3NU, UK
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Byrne EM, Pascoe M, Cooper D, Armstrong TS, Gilbert MR. Challenges and limitations of clinical trials in the adolescent and young adult CNS cancer population: A systematic review. Neurooncol Adv 2024; 6:vdad159. [PMID: 38250563 PMCID: PMC10798804 DOI: 10.1093/noajnl/vdad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Background The adolescent and young adult (AYA) cancer population, aged 15-39, carries significant morbidity and mortality. Despite growing recognition of unique challenges with this age group, there has been little documentation of unmet needs in their care, trial participation, and quality of life, particularly in those with primary brain tumors. Methods A systematic literature review of 4 databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Studies included editorials, reviews, and practice guidelines on the challenges and limitations faced by the AYA population. Papers had to address CNS tumors. Results Sixty-eight studies met the inclusion criteria. The challenges and limitations in clinical trials in the AYA population were synthesized into 11 categories: molecular heterogeneity, tumor biology, diagnostic delay, access to care, physician factors, patient factors, primary brain tumor (PBT) factors, accrual, limited trials, long term follow up, and trial design. The published papers' recommendations were categorized based on the target of the recommendation: providers, coordination of care, organizations, accrual, and trial design. The AYA cancer population was found to suffer from unique challenges and barriers to care and the construction of trials. Conclusions The AYA CNS cancer population suffers from unique challenges and barriers to care and construction of trials that make it critical to acknowledge AYAs as a distinct patient population. In addition, AYAs with primary brain tumors are underrecognized and underreported in current literature. More studies in the AYA primary brain tumor patient population are needed to improve their care and participation in trials.
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Affiliation(s)
- Emma M Byrne
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Maeve Pascoe
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Diane Cooper
- National Institute of Health Library, National Institute of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
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Ferrari A, Gatz SA, Minard-Colin V, Alaggio R, Hovsepyan S, Orbach D, Gasparini P, Defachelles AS, Casanova M, Milano GM, Chisholm JC, Jenney M, Bisogno G, Rogers T, Mandeville HC, Shipley J, Miah AB, Merks JHM, van der Graaf WTA. Shedding a Light on the Challenges of Adolescents and Young Adults with Rhabdomyosarcoma. Cancers (Basel) 2022; 14:6060. [PMID: 36551545 PMCID: PMC9775932 DOI: 10.3390/cancers14246060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a typical tumour of childhood but can occur at any age. Several studies have reported that adolescent and young adult (AYA) patients with RMS have poorer survival than do younger patients. This review discusses the specific challenges in AYA patients with pediatric-type RMS, exploring possible underlying factors which may influence different outcomes. Reasons for AYA survival gap are likely multifactorial, and might be related to differences in tumor biology and intrinsic aggressiveness, or differences in clinical management (that could include patient referral patterns, time to diagnosis, enrolment into clinical trials, the adequacy and intensity of treatment), as well as patient factors (including physiology and comorbidity that may influence treatment tolerability, drug pharmacokinetics and efficacy). However, improved survival has been reported in the most recent studies for AYA patients treated on pediatric RMS protocols. Different strategies may help to further improve outcome, such as supporting trans-age academic societies and national/international collaborations; developing specific clinical trials without upper age limit; defining integrated and comprehensive approach to AYA patients, including the genomic aspects; establishing multidisciplinary tumor boards with involvement of both pediatric and adult oncologists to discuss all pediatric-type RMS patients; developing dedicated projects with specific treatment recommendations and registry/database.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Susanne Andrea Gatz
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Veronique Minard-Colin
- Department of Paediatric and Adolescent Oncology, Gustave-Roussy, Cancer Campus, Université Paris-Saclay, 94805 Villejuif, France
| | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Roma, Italy
| | - Shushan Hovsepyan
- Pediatric Cancer and Blood Disorders Centre of Armenia, Yerevan 0014, Armenia
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, 75005 Paris, France
| | - Patrizia Gasparini
- Tumor Genomics Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | | | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | | | - Julia C. Chisholm
- Children and Young People’s Unit, Royal Marsden Hospital and The Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children′s Hospital for Wales, Heath Park, Cardiff CF14 4XW, UK
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Janet Shipley
- Sarcoma Molecular Pathology Team, Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London SM2 5NG, UK
| | - Aisha B. Miah
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London SM2 5NG, UK
| | - Johannes H. M. Merks
- Princess Máxima Center for Paediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Winette T. A. van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, 3062 PA Rotterdam, The Netherlands
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6
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Faure Conter C, Calaminus G, Nicholson J, Idbaih A, Hoang Xuan K, Vasiljevic A, Morana G, Szathmari A, Ajithkumar T, Frappaz D. Central nervous system germ cell tumor, an archetypal AYA tumor and a model for pediatric and neuro-oncology collaboration, review from the EURACAN domain 10 group. Front Oncol 2022; 12:971697. [PMID: 36248981 PMCID: PMC9557181 DOI: 10.3389/fonc.2022.971697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary: Adolescents and young adults (AYA) with cancer often fall through gaps between children's and adults' cancer services. They are consequently under-represented in clinical trials, and their survival is often inferior to that of children or adults with the same tumor type; in this paper, we use the example of central nervous system germ cell tumors (CNS-GCT), as a model of AYA tumor to illustrate this challenge. We describe how we have built bridges between pediatric and adult oncology, how this can apply to other types of brain tumors, and discuss ways to promote cancer care in the AYA population. Adolescents and young adults (AYA) with cancer are under-represented in clinical trials and have thus not benefited from the same improvement in outcomes as either younger or older patients. Central nervous system germ cell tumors (CNS-GCT) represent an ideal model of AYA tumor as their incidence peaks during adolescence and young adulthood. Since the early 90's, SIOP (International Society of Pediatric Oncology) has launched two successive European trials: SIOP CNS-GCT96 (January 1996 to December 2005) and SIOP CNS-GCTII protocols (October 2011 to July 2018), for CNS-GCTs. With the removal of the upper age limit in the SIOP CNS-GCTII trial, and closer collaboration between pediatric and adult oncologists within AYA multidisciplinary tumor boards, the proportion of adults enrolled in France has dramatically increased over time. The current article will use the example of CNS-GCT to illustrate how to build a bridge between pediatric and adult oncology, how this can apply to other types of brain tumors, and how to promote cancer care in the AYA population.
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Affiliation(s)
- Cecile Faure Conter
- Institute of Pediatric Hematology and Oncology, Lyon, France,*Correspondence: Cecile Faure Conter,
| | | | - James Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Khê Hoang Xuan
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Alexandre Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin, Italy
| | - Alexandru Szathmari
- Department of Neurosurgery, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Thankamma Ajithkumar
- Department of Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Didier Frappaz
- Institute of Pediatric Hematology and Oncology, Lyon, France
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7
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Quarello P, Toss A, Mascarin M, Banna GL, Canesi M, Milano GM, Incorvaia L, Lambertini M, Terenziani M, Clerici CA, Vigevani GE, Beretta GD, Prete A, Cinieri S, Peccatori FA, Ferrari A. Get up, stand up: Alongside adolescents and young adults with cancer for their right to be forgotten. TUMORI JOURNAL 2022; 108:402-406. [PMID: 35674140 DOI: 10.1177/03008916221101652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescent and young adult cancer survivors may experience various forms of social difficulties years or even decades after completing their cancer treatments. This article will hopefully help the Italian national project dedicated to adolescents and young adults with cancer promoting political and legal solutions to stop discrimination and supporting the right to be forgotten.
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Affiliation(s)
- Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy.,University of Torino, Torino, Italy
| | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Moderna, Italy
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Giuseppe Luigi Banna
- Interdisciplinary Group for Translational Research and Clinical Trials, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Marta Canesi
- Department of Pediatrics, University of Milano-Bicocca, Fondazione MBBM/ASST-Monza, Monza, Italy
| | | | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences Section of Medical Oncology University of Palermo, Palermo, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Departament of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.,Department of Oncology and Hemato-oncology, University of Milano, Milano, Italy
| | | | | | - Arcangelo Prete
- Hematology-Oncology Unit, Department of Pediatrics - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Saverio Cinieri
- Medical Oncology Unit and Breast Unit, Ospedale Perrino ASL Brindisi, Brindisi, Italy
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Cozzi G, Passaglia L, Agrusti A, Giangreco M, Giorgi R, Barbi E. Adolescents' Utilization of a Tertiary-Level Pediatric Emergency Department in Italy. Front Pediatr 2022; 10:750403. [PMID: 35359905 PMCID: PMC8960306 DOI: 10.3389/fped.2022.750403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Aim Describe the use of the emergency department of a tertiary-level children's hospital in Italy by adolescents. Methods This retrospective study was based on the medical records of patients aged 13 to 17 years, who accessed the emergency department of the Institute for Maternal and Child Health of Trieste, from 1 January to 31 December 2018. The primary outcome was to describe the leading causes of access, diagnoses, rate of hospitalization, and ward of destination among adolescent patients. Results During the study period, 24,599 patients accessed the department. Among them, 3,062 were adolescents, for a total of 3,895 unscheduled visits. The principal causes of access were trauma (45.3%) and organic diseases (38.8%). Two hundred and forty nine adolescents (6.4%) had mental health problems. One hundred and forty two adolescents (3.6%) Were Admitted to the Hospital, 54 of Whom (38%) to the Neuropsychiatric Ward, for Mental Health Problems. Conclusions Among adolescents seen in this Italian tertiary-level children's hospital, mental health problems represented a small proportion of emergency department visits but were the leading cause of urgent hospitalization.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Rita Giorgi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- University of Trieste, Trieste, Italy
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9
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Ferrari A, Quarello P, Mascarin M, Luigi Banna G, Toss A, Sironi G, Zecca M, Cinieri S, Alessandro Peccatori F. Italian pediatric and adult oncology communities join forces for a national project dedicated to adolescents and young adults with cancer. TUMORI JOURNAL 2021; 108:104-110. [PMID: 34841968 DOI: 10.1177/03008916211058790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescents and young adults with cancer have substantially different clinical and psychological needs compared to those of pediatric patients and of older adult patients. We describe the development of an Italian national project dedicated to adolescents and young adults with cancer.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, University of Torino, Italy
| | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Giuseppe Luigi Banna
- Interdisciplinary Group for Translational Research and Clinical Trials, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Angela Toss
- Department of Oncology and Hematology, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Saverio Cinieri
- Medical Oncology Unit and Breast Unit, Ospedale Perrino ASL Brindisi, Italy
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10
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Ferrari A, Stark D, Peccatori FA, Fern L, Laurence V, Gaspar N, Bozovic-Spasojevic I, Smith O, De Munter J, Derwich K, Hjorth L, van der Graaf WTA, Soanes L, Jezdic S, Blondeel A, Bielack S, Douillard JY, Mountzios G, Saloustros E. Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 2021; 6:100096. [PMID: 33926710 PMCID: PMC8103533 DOI: 10.1016/j.esmoop.2021.100096] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.
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Affiliation(s)
- A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - D Stark
- Leeds Institute of Medical Research, School of Medicine University of Leeds, Leeds, UK.
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Fern
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Laurence
- Medical Oncology Department and SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - N Gaspar
- Department of Oncology for Child and Adolescent, Gustave Roussy Cancer Campus, Villejuif, France
| | - I Bozovic-Spasojevic
- Medical Oncology Department, Institute for Oncology and Radiology of Serbia, Belgrade, Republic of Serbia
| | - O Smith
- National Children's Cancer Service, Children's Health Ireland at Crumlin and Systems Biology Ireland, University College Dublin, Dublin, Ireland
| | - J De Munter
- University Hospital Ghent Cancer Center, UZ Gent, Ghent, Belgium
| | - K Derwich
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - L Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | - W T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L Soanes
- Teenage Cancer Trust, London, UK
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - A Blondeel
- Department of Scientific Programme Coordination, European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
| | - S Bielack
- Zentrum für Kinder, Jugend und Frauenmedizin Pädiatrie 5, KlinikumStuttgart - Olgahospital, Stuttgart, Germany
| | - J-Y Douillard
- Scientific and Medical Division, European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Mountzios
- 2nd Department of Medical Oncology and Clinical Trial Unit, Henry Dunant Hospital, Athens, Greece
| | - E Saloustros
- Department of Oncology, University Hospital of Larissa, Larissa, Greece
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Makhnoon S, Corredor J, Arun B, Bell D, Yarbrough A, Livingston JA, Peterson SK, Roth M. Impact of a Genetic Evaluation Initiative to Increase Access to Genetic Services for Adolescent and Young Adults at a Tertiary Cancer Hospital. J Adolesc Young Adult Oncol 2020; 10:296-302. [PMID: 32830989 DOI: 10.1089/jayao.2020.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYAs) with cancer are at increased risk for inherited cancer predisposition syndromes. Genetic counseling (GC) is important for accurate risk assessment, diagnosis, and management of inherited cancers. Numerous barriers prevent AYA access to genetic services. This study describes outcomes of a genetic evaluation initiative (GEI) regarding utilization of genetic services among AYAs. Methods: To improve AYA access to GC, the AYA program at UT MD Anderson Cancer Center implemented GEI, a process for identifying and referring eligible patients for GC. We collected retrospective electronic medical record data between July 12, 2018 and July 12, 2019 to capture AYA's clinical characteristics, genetic referral, scheduled appointments, counseling, testing, and results. Results: In total, 516 AYAs were referred to the AYA clinic during the study period with a median age of first cancer diagnosis of 17 years. One hundred sixty-six AYAs were identified who would benefit from genetic evaluation, 57 (34.3%) of whom had previously undergone counseling. One hundred nine patients were recommended for referral to GC, and 64.2% (70/109) were referred by the AYA team. To date, 58.6% (41/70) met with a genetic counselor and 75.6% (31/41) completed genetic testing, which yielded 1 pathogenic, 2 uncertain, and 29 benign results. Conclusion: The GEI resulted in a 72.0% relative increase in the rate of GC utilization and represents a novel approach to increasing AYA patient access to cancer genetic services in this population.
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Affiliation(s)
- Sukh Makhnoon
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Corredor
- Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Banu Arun
- Clinical Cancer Genetics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donna Bell
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Angela Yarbrough
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Andrew Livingston
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Roth
- Department of Pediatrics, and University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Grossoehme DH, Friebert S, Baker JN, Tweddle M, Needle J, Chrastek J, Thompkins J, Wang J, Cheng YI, Lyon ME. Association of Religious and Spiritual Factors With Patient-Reported Outcomes of Anxiety, Depressive Symptoms, Fatigue, and Pain Interference Among Adolescents and Young Adults With Cancer. JAMA Netw Open 2020; 3:e206696. [PMID: 32543698 PMCID: PMC7298609 DOI: 10.1001/jamanetworkopen.2020.6696] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE The associations of spiritual and religious factors with patient-reported outcomes among adolescents with cancer are unknown. OBJECTIVE To model the association of spiritual and religious constructs with patient-reported outcomes of anxiety, depressive symptoms, fatigue, and pain interference. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used baseline data, collected from 2016 to 2019, from an ongoing 5-year randomized clinical trial being conducted at 4 tertiary-referral pediatric medical centers in the US. A total of 366 adolescents were eligible for the clinical trial, and 126 were randomized; participants had to be aged 14 to 21 years at enrollment and be diagnosed with any form of cancer. Exclusion criteria included developmental delay, scoring greater than 26 on the Beck Depression Inventory II, non-English speaking, or unaware of cancer diagnosis. EXPOSURES Spiritual experiences, values, and beliefs; religious practices; and overall self-ranking of spirituality's importance. MAIN OUTCOMES AND MEASURES Variables were taken from the Brief Multidimensional Measurement of Religiousness/Spirituality (ie, feeling God's presence, daily prayer, religious service attendance, being very religious, and being very spiritual) and the spiritual well-being subscales of the Functional Assessment of Chronic Illness Therapy (meaning/peace and faith). Predefined outcome variables were anxiety, depressive symptoms, fatigue, and pain interference from Patient-Reported Outcomes Measurement Information System pediatric measures. RESULTS A total of 126 individuals participated (72 [57.1%] female participants; 100 [79.4%] white participants; mean [SD] age, 16.9 [1.9] years). Structural equation modeling showed that meaning and peace were inversely associated with anxiety (β = -7.94; 95% CI, -12.88 to -4.12), depressive symptoms (β = -10.49; 95% CI, -15.92 to -6.50), and fatigue (β = -8.90; 95% CI, -15.34 to -3.61). Feeling God's presence daily was indirectly associated with anxiety (β = -3.37; 95% CI, -6.82 to -0.95), depressive symptoms (β = -4.50; 95% CI, -8.51 to -1.40), and fatigue (β = -3.73; 95% CI, -8.03 to -0.90) through meaning and peace. Considering oneself very religious was indirectly associated with anxiety (β = -2.81; 95% CI, -6.06 to -0.45), depressive symptoms (β = -3.787; 95% CI, -7.68 to -0.61), and fatigue (β = -3.11, 95% CI, -7.31 to -0.40) through meaning and peace. Considering oneself very spiritual was indirectly associated with anxiety (β = 2.11; 95% CI, 0.05 to 4.95) and depression (β = 2.8, 95% CI, 0.07 to 6.29) through meaning and peace. No associations were found between spiritual scales and pain interference. CONCLUSIONS AND RELEVANCE In this study, multiple facets of spirituality and religiousness were associated with anxiety, depression, and fatigue, all of which were indirectly associated with the participant's sense of meaning and peace, which is a modifiable process. Although these results do not establish a causal direction, they do suggest palliative interventions addressing meaning-making, possibly including a spiritual or religious dimension, as a novel focus for intervention development.
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Affiliation(s)
- Daniel H. Grossoehme
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
| | - Sarah Friebert
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Jennifer Needle
- Division of Pediatric Critical Care Medicine, University of Minnesota Health, Minneapolis
| | - Jody Chrastek
- Pediatric Palliative Care, University of Minnesota Health–Fairview, Minneapolis
| | - Jessica Thompkins
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, DC
- Center for Translational Research at Children’s National Research Institute, Washington, DC
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research at Children’s National Research Institute, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research at Children’s National Research Institute, Washington, DC
| | - Maureen E. Lyon
- Division of Adolescent and Young Adult Medicine, Children’s National Hospital, Washington, DC
- Center for Translational Research at Children’s National Research Institute, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
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13
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Dilday JC, Nelson DW, Fischer TD, Goldfarb M. Disparities in Amputation Rates for Non-metastatic Extremity Soft Tissue Sarcomas and the Impact on Survival. Ann Surg Oncol 2020; 28:576-584. [PMID: 32409968 DOI: 10.1245/s10434-020-08586-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are no definitive recommendations guiding amputation use in extremity soft tissue sarcomas (STSs). This study explores disparities in amputation rates and survival in patients with non-metastatic adult-type extremity STSs. METHODS Patients with non-metastatic adult-type extremity STSs were identified from the 1998-2012 National Cancer Database. Factors affecting amputation were examined across all ages and separately in adults (> 40 years), adolescent/young adults (AYA: ages 15-39), and children (age < 15). Impact on 10-year overall survival (OS) was explored. RESULTS Of 15,886 patients, 4.65% had an amputation. AYAs had the most amputations (6.4%) compared to children (5.9%) and adults (4.2%) (p < 0.001). Patients with public insurance (OR 1.3, CI 1.08-1.58) and from central states (OR 1.5, CI 1.2-1.86) were more likely to undergo amputation, whereas those from high income brackets (OR 0.8, CI 0.62-0.94) and treated at community cancer centers were less likely (OR 0.7, CI 0.62-0.90). Amputation was an independent risk factor for death at 10 years, with the greatest impact in AYAs compared to older adults (HR 1.7, p < 0.001). Treatment in eastern or central states, lower income, lack of private insurance, and comorbidities were all associated with decreased OS (all p < 0.05). Female gender (HR 0.8, CI 0.78-0.89) and high-volume centers (HR 0.8, CI 0.74-0.94) were associated with improved OS. CONCLUSIONS Although amputations for extremity STSs are rare, disparities exist across age groups, insurance and geography when it comes to the use of amputation in patients with extremity STSs. Moreover, having an amputation is an independent risk factor for death, with the greatest impact in AYAs.
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Affiliation(s)
- Joshua C Dilday
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Trevan D Fischer
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Melanie Goldfarb
- Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA. .,Center for Endocrine Tumors and Disorders, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
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14
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Evolving Services for Adolescents with Cancer in Italy: Access to Pediatric Oncology Centers and Dedicated Projects. J Adolesc Young Adult Oncol 2020; 9:196-201. [DOI: 10.1089/jayao.2019.0134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Lewin J, Bell JAH, Wang K, Forcina V, Tam S, Srikanthan A, Lin YC, Taback N, Mitchell L, Gupta AA. Evaluation of Adolescents’ and Young Adults’ Attitudes Toward Participation in Cancer Clinical Trials. JCO Oncol Pract 2020; 16:e280-e289. [DOI: 10.1200/jop.19.00450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE: Participation in cancer clinical trials (CCTs) for adolescents and young adults (AYAs) remains the lowest of any patient group with cancer. Little is known about the personal barriers to AYA accrual. The aim of this study was to explore AYA attitudes that influence CCT participation. METHODS: A mixed-methods approach was used. AYAs and non-AYAs (≥ 40 years) completed the Cancer Treatment subscale of the Attitudes Toward Cancer Trials Scales and 9 supplementary questions formed from interview analysis. Differences between AYA and non-AYA cohorts were analyzed using the Mann-Whitney U test, and logistic regression models were constructed to evaluate the effect of demographics on perceptions of CCTs. RESULTS: Surveys were distributed to 61 AYAs (median age, 29 years; range, 17-39 years) and 74 non-AYAs (median age, 55 years; range, 40-88 years). Compared with non-AYAs, AYAs perceived CCTs to be unsafe/more difficult (Personal Barrier/Safety domain; P = .01). There were no differences based on age in other domains. AYAs were also more concerned with CCT interference in their long-term goals ( P = .04). Multivariable ordered logistic regression identified increased personal barriers in the Personal Barrier/Safety domain for AYAs ( P = .01), in patients with English as a second language (ESL; P < .01), and in patients previously not offered a clinical trial ( P = .03). Long-term goals were identified as a barrier in particular tumor types ( P = .01) and in patients with ESL ( P < .01), with a trend identified in AYAs ( P = .12). CONCLUSION: Age-related differences in attitudes toward CCTs suggest that tailored approaches to CCT accrual are warranted. Patient-centered delivery of information regarding CCTs, particularly in patients with ESL and who are trial naïve, may improve accrual.
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Affiliation(s)
- Jeremy Lewin
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jennifer A. H. Bell
- Department of Bioethics, University Health Network; Department of Supportive Care, Princess Margaret Cancer Centre; and Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Wang
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Victoria Forcina
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Seline Tam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Yu-Chung Lin
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Taback
- Departments of Statistical Science and Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Laura Mitchell
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Abha A. Gupta
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princes Margaret Cancer Center, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Ferrari A, Bernasconi A, Sironi G, Bergamaschi L, Botta L, Chiaravalli S, Casanova M, Bisogno G, Milano GM, Mascarin M, Tornesello A, Quarello P, Massimino M, Gatta G, Trama A. Where Are Adolescents with Soft Tissue Sarcomas Treated? An Italian Nationwide Study on Referrals Based on Hospital Discharge Records. J Adolesc Young Adult Oncol 2019; 9:190-195. [PMID: 31660779 DOI: 10.1089/jayao.2019.0117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents (15-19 years) with soft tissue sarcomas (STS) have worse survival than children. One reason is the former's limited access to expert centers. We investigated where adolescents with STS are treated in Italy, analyzing hospital discharge records (HDRs) countrywide. Methods: We applied to the Health Ministry to obtain the HDRs of all adolescents hospitalized in 2002-2015. We excluded prevalent cases hospitalized with STS in 2002-2006 to obtain a cohort of incident cases 2007-2014. We defined main treatments observing 12 months from diagnosis. Thus, the cohorts end in 2014 rather than 2015. We computed "hospital volume" as the number of adolescents treated by a hospital in 8 years. Patient migration across geographical areas was investigated comparing patients' place of residence and of hospitalization. Results: We identified 381 adolescents with STS, 63% of them were treated at AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica [Italian Association of Pediatric Hematology and Oncology]) centers. These patients were treated at 44 different AIEOP centers, with 1 center treating 62 adolescents (26% of all those treated by AIEOP centers). The remaining 142 adolescents with STS were treated at 66 non-AIEOP centers, one of which managed 17 adolescents. Centers in the north of Italy were more likely to attract patients from other regions. Conclusion: Although HDRs have some limitations, they are the only tool for investigating access to care in countries without national cancer registries. Our findings support the use of HDRs for such purposes, confirm the efficacy of the Italian pediatric oncology network, and make the case for closer collaboration between pediatric and adult oncologists.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gianni Bisogno
- Hematology-Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | | | - Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Paola Quarello
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research in Epidemiological and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Conducting Psychosocial Intervention Research among Adolescents and Young Adults with Cancer: Lessons from the PRISM Randomized Clinical Trial. CHILDREN-BASEL 2019; 6:children6110117. [PMID: 31652895 PMCID: PMC6915330 DOI: 10.3390/children6110117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer have poor psychosocial outcomes, in part because their limited participation in clinical trials precludes intervention-testing. We previously reported results of a successful randomized trial testing an AYA-targeted psychosocial intervention. Here, we aimed to describe strategies learned during the trial's conduct. METHODS We summarized data from the medical record and staff field notes regarding reasons for participation/non-participation. We conducted two focus groups with study staff; directed content analyses identified strategies for success. RESULTS 92 AYAs enrolled (77% of approached; n = 50 Usual Care (control), n = 49 PRISM (intervention)). In eligible families who declined participation (n = 22 AYAs, n = 8 parents), the AYAs more commonly had advanced cancer (n = 11 (37%) declined vs. n = 25 (26%) enrolled). AYA reasons for non-enrollment were predominantly "not interested"; parents worried participation was "too burdensome." Staff strategies for accrual included having significant time to introduce the study and underscoring a desire to learn from the patient. After enrollment, AYAs who discontinued participation were more commonly assigned to control (n = 5 (10%) control vs. n = 2 (4%) intervention). Only n = 1 AYA chose to discontinue participation after receiving the intervention. CONCLUSIONS Efforts to engage AYAs prior to and during studies may help with accrual and retention.
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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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Dynamics and Challenges of Clinical Trials in Adolescents and Young Adults With Cancer. ACTA ACUST UNITED AC 2019; 24:307-314. [PMID: 30480575 DOI: 10.1097/ppo.0000000000000347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Inclusion in cancer clinical trials is considered the optimal standard of care, offering improved patient experience and progressive survival gains for subsequent generations of patients. Adolescent and young adult (AYA) patients are underrepresented in cancer research; consequently, improvements in outcomes for AYAs lag behind their pediatric and adult counterparts. Despite international evidence of underrepresentation in research, systematically tested interventions to improve recruitment for AYAs do not exist, and recruitment rates for AYAs continue to be lower than those for children. We review recruitment of AYAs into trials and discuss barriers and facilitators.
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Barakat LP, Stevens E, Li Y, Reilly A, Deatrick JA, Goldstein NE, Schwartz LA. Evaluation of the Pediatric Research Participation Questionnaire for Measuring Attitudes Toward Cancer Clinical Trials Among Adolescents and Young Adults. J Adolesc Young Adult Oncol 2019; 8:423-433. [PMID: 31025898 PMCID: PMC8666797 DOI: 10.1089/jayao.2018.0144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Reasons for the relatively low rates of adolescent and young adults (AYA) enrollment in cancer clinical trials in the United States require further empirical examination. In addition to structural factors such as lack of access and insurance barriers, attitudes toward clinical trials may be important to consider. This study aimed to evaluate and validate the Pediatric Research Participation Questionnaire (PRPQ)-a measure of attitudes to clinical trials adapted for AYA (15-29) with cancer and their caregivers. Methods: One hundred twenty-four AYA and 94 caregivers completed the PRPQ-AYA and measures of clinical trial knowledge and developmental/emotional maturity. Factor analysis evaluated the PRPQ-AYA structure, interitem reliability was computed, and Pearson correlations examined associations of validation measures with factor scores and computed scores reflecting perceived barriers, perceived benefits, and decision balance. Results: Confirmatory factor analysis did not confirm the prior PRPQ factor structure. Exploratory factor analysis suggested a new four-factor structure for: AYA (1) trust/mistrust, (2) barriers/costs, (3) support for participation, and (4) incentives; and caregivers (1) trust/access, (2) mistrust/costs, (3) support for participation, and (4) risks to AYA. Factor scores and barriers, benefits, and decision balance scores demonstrated acceptable interitem reliability and were significantly correlated with clinical trial knowledge and emotional maturity in the expected direction. Conclusion: PRPQ-AYA factor structure for AYA and caregivers varied and should be interpreted cautiously due to limited power. Simple solutions of perceived benefits, perceived barriers, and decision balance were reliable and valid and provide important information to address and engage AYA through the clinical trial informed consent process.
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Affiliation(s)
- Lamia P. Barakat
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Evelyn Stevens
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yimei Li
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anne Reilly
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Janet A. Deatrick
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Lisa A. Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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21
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Mou J, Bolieu EL, Pflugeisen BM, Amoroso PJ, Devine B, Baldwin LM, Frank LL, Johnson RH. Delay in Treatment After Cancer Diagnosis in Adolescents and Young Adults: Does Facility Transfer Matter? J Adolesc Young Adult Oncol 2019; 8:243-253. [PMID: 30785806 PMCID: PMC6909758 DOI: 10.1089/jayao.2018.0128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Timeliness is one of the fundamental yet understudied quality metrics of cancer care. Little is known about cancer treatment delay among adolescent and young adult (AYA) cancer patients. This study assessed cancer treatment delay, with a specific focus on facility transfer and diagnosis/treatment interval. Methods: Based on MultiCare Health System's (MHS's) institutional cancer registry data of AYA patients diagnosed during 2006-2015, this study analyzed patient demographics, insurance, clinical characteristics, and time of diagnosis and treatment initiation. Chi-squared tests, cumulative hazard estimates, and Cox proportional regression were used for univariable analysis. Multivariate regression models were used to test the association between care transfer and days of interval or prolonged delay, controlling for baseline parameters. Results: Of 840 analytic AYA cases identified, 457 (54.5%) were both diagnosed and treated within MHS. A total of 45.5% were either diagnosed or treated elsewhere. Mean and median intervals for treatment initiation were 27.03 (95% CI = 21.94-33.14) and 8.00 days (95% CI = 5.00-11.00), respectively, with significant differences between patients with and without facility transfer. Transfer was significantly correlated with longer length of diagnosis-to-treatment interval. Treatment delay, ≥1 week, was associated with transfer, female sex, older age, no surgery involvement, and more treatment modalities. Treatment delay, ≥4 weeks, was associated with transfer, female sex, no insurance, and no surgery involvement. Conclusion: In a community care setting, the diagnosis-to-treatment interval is significantly longer for transferred AYA cancer patients than for patients without a transfer. Future studies are warranted to explore the prognostic implications and the reasons for delays within specific cancer types.
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Affiliation(s)
- Jin Mou
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | | | | | - Paul J. Amoroso
- MultiCare Institute for Research & Innovation, Tacoma, Washington
| | - Beth Devine
- Department of Health Services, University of Washington, Seattle, Washington
| | - Laura-Mae Baldwin
- Department of Family Medicine, Community Engagement, Institute of Translational Health Sciences, University of Washington, Seattle, Washington
| | - Laura L. Frank
- MultiCare Institute for Research & Innovation, Tacoma, Washington
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22
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Rangarajan HG, Smith LC, Stanek JR, Hall M, Abu-Arja R, Auletta JJ, O'Brien SH. Increased Health Care Utilization and Costs during Allogeneic Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndromes in Adolescents and Young Adults Compared with Children: A Multicenter Study. Biol Blood Marrow Transplant 2019; 25:1031-1038. [DOI: 10.1016/j.bbmt.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022]
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23
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Metzger ML, Mauz-Körholz C. Epidemiology, outcome, targeted agents and immunotherapy in adolescent and young adult non-Hodgkin and Hodgkin lymphoma. Br J Haematol 2019; 185:1142-1157. [PMID: 30729493 DOI: 10.1111/bjh.15789] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The epidemiology, outcome and targeted immunotherapy in adolescent and young adult non-Hodgkin and Hodgkin lymphoma were discussed during the 6th International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma September 26th-29th 2018 in Rotterdam, the Netherlands. This review summarizes some of those presentations, as well as other current and novel antibody therapy, immune check-point inhibitors, chimeric antigen receptor T cells, cancer vaccines and cytotoxic T lymphocyte therapy.
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Affiliation(s)
- Monika L Metzger
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Christine Mauz-Körholz
- Pädiatrische Hämatologie und Onkologie, Justus-Liebig-Universität Gießen and Medical Faculty of the Martin-Luther University of Halle, Germany
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24
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Clinical Trial Enrollment is Associated With Improved Follow-up Rates Among Survivors of Childhood Cancer. J Pediatr Hematol Oncol 2019; 41:e18-e23. [PMID: 29668542 PMCID: PMC6854689 DOI: 10.1097/mph.0000000000001169] [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] [Indexed: 11/26/2022]
Abstract
Fortunately >80% of children diagnosed with cancer become long-term survivors; however, this population is at a significantly increased risk of morbidity and mortality as a result of their previous cancer therapy, and long-term follow-up (LTFU) is critical. Multiple barriers to receiving adequate LTFU care have been studied. We investigated whether lack of enrollment in a therapeutic clinical trial may be a barrier to receiving LTFU care. We conducted a review of 353 patient records at the Children's Hospital of Michigan enrolled in our Children's Oncology Group registry between January 1, 2005 and December 31, 2010. In total, 71 patients were excluded (death before follow-up, n=61; currently receiving therapy, n=5; known transfer of care, n=4; insufficient information, n=1). In total, 158 (56%) patients were enrolled in a therapeutic clinical trial. Follow-up rates at 1-, 2- and 5-years following completion of therapy for patients enrolled in a therapeutic clinical trial were 96.8% (153/158), 93.7% (148/158), and 81.7% (103/126), respectively, compared with 83.1% (103/124; P<0.001), 74.2% (92/124; P<0.001), and 66.7% (72/108; P=0.001) for patients not enrolled. Our findings suggest patients enrolled in a therapeutic clinical trial have better LTFU rates and supports the importance of patient enrollment in therapeutic clinical trials when possible. Additional resources may be warranted to improve LTFU for patients not enrolled.
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25
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Flerlage JE, Metzger ML, Bhakta N. The management of Hodgkin lymphoma in adolescents and young adults: burden of disease or burden of choice? Blood 2018; 132:376-384. [PMID: 29895665 PMCID: PMC6071556 DOI: 10.1182/blood-2018-01-778548] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/01/2018] [Indexed: 12/18/2022] Open
Abstract
Adolescents and young adults (AYAs) comprise the largest age group affected by Hodgkin lymphoma (HL). Despite excellent overall survival of AYA patients with HL due to advances in treatment regimens, therapy-associated late effects continue to be a concern in HL survivors, especially for younger patients who have decades of life remaining. Since the first clinical trial for HL with chemotherapy in 1964, subsequent protocols have attempted to reduce chemotherapy-induced toxicities and yet maintain high overall survival rates. Today, new analytic methods applied to data from survivorship cohorts, such as the recently described cumulative burden of disease metric, can be used to inform changes for future protocols. Although pediatric and adult trial consortia have followed this process, the AYA population, an age cohort split between pediatric and adult health care services, faces many barriers to care and is the least likely to be enrolled in clinical trials. AYA patients with HL theoretically have a choice to be treated in pediatric or adult protocols when presented with these options. Recent efforts by the National Clinical Trials Network, the Children's Oncology Group, and others have been made to ensure that the burden of choice for the AYA population is not greater than the burden of disease.
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Affiliation(s)
- Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- The University of Tennessee Health Sciences Center, Memphis, TN; and
| | - Monika L Metzger
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- The University of Tennessee Health Sciences Center, Memphis, TN; and
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- The University of Tennessee Health Sciences Center, Memphis, TN; and
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
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26
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Improving healthcare in pediatric oncology: development and testing of multiple indicators to evaluate a hub-and-spoke model. TUMORI JOURNAL 2018; 104:459-465. [DOI: 10.5301/tj.5000645] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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McVeigh TP, Sundar R, Diamantis N, Kaye SB, Banerji U, Lopez JS, de Bono J, van der Graaf WTA, George AJ. The role of genomic profiling in adolescents and young adults (AYAs) with advanced cancer participating in phase I clinical trials. Eur J Cancer 2018; 95:20-29. [PMID: 29614442 PMCID: PMC6296443 DOI: 10.1016/j.ejca.2018.02.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Adolescents and young adults (AYAs) diagnosed with cancer between ages 15-39 years may harbour germline variants associated with cancer predisposition. Such variants represent putative therapeutic targets, as may somatic variants in the tumour. Germline and tumour molecular profiling is increasingly utilised to facilitate personalisation of cancer treatment in such individuals. AIM Considering AYAs with advanced solid tumours managed in a specialist drug development unit (DDU), the aims of this study were to investigate the use and impact of: 1. Germline genetic assessment. 2. Tumour molecular profiling. METHODS AYAs treated in the DDU at the Royal Marsden Hospital between 2002 and 2016 were identified from departmental databases. Data regarding clinicopathological features, clinical assessments and germline and tumour genetic testing were retrieved by chart review. RESULTS The study cohort included 219 AYAs. Common cancer types included sarcoma (41, 19%); cervical (27, 12%); breast (25, 11%); ovarian (23, 11%) and colorectal (21, 10%) cancers. Germline testing was undertaken in 34 (16%) patients, 22 of whom carried a pathogenic variant. Using current testing criteria, an additional 32 (15%) would be eligible for germline testing based on their personal history of cancer alone. Tumour testing was undertaken in 46 (21%) individuals. Somatic mutations were commonly identified in TP53 13 (28%); PIK3CA (8, 18%); KRAS (4, 9%) and MET 5 (11%). DISCUSSION A significant proportion of AYAs with advanced cancer have targetable somatic or germline mutations. Consideration of familial risk factors and inclusion of germline testing wherever appropriate can complement tumour testing to optimise patient management and inform management of at-risk relatives.
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Affiliation(s)
| | - Raghav Sundar
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK; Department of Haematology-Oncology, National University Health System, Singapore
| | - Nikolaos Diamantis
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Stan B Kaye
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Juanita S Lopez
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | - Johann de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
| | | | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK; Gynaecology Unit, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, UK
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28
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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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29
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Scurti V, Di Ienno S, Fanizza C, Belfiglio M, D'ettorre A, Romero M, Tognoni G. Hospital Discharge Database as a Tool to Monitor Incidence, Survival and Burden of Cancer in Adolescents and Young Adults. TUMORI JOURNAL 2018; 98:19-26. [DOI: 10.1177/030089161209800102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background Cancer in young patients (15–39 years) is unique for the distribution of types, therapeutic options and clinical evolution. Administrative databases represent well-documented tools in epidemiology, and in oncology they are very important in those realities without cancer registries. Our study aimed to analyze the occurrence, outcomes and burden of cancer in young patients through the analysis of hospital discharge records. Methods Hospital discharge databases and civil registries were analyzed through record linkage technique. Annual incidence rate (AIR), standardized incidence rate (SR), overall survival, hospitalization rate, and mean number of hospitalizations were evaluated. Results Among 2,330,459 young adults, 1846 new cancer patients had been hospitalized in the analyzed period. The SR was 69.3/100,000/year: 1051, 56.9%, were females (AIR 91.0 and SR 76.0) and 795, 43.1%, were males (AIR 67.6 and SR 62.5). Hematological disease was more frequent in males than females (25.5% vs 14.7%, P <0.0001), whereas solid tumors were more frequent among females (85.3% vs 74.5, P <0.0001). The distribution by diagnostic group showed that among females breast cancer was the most frequent (n = 272, SR 17.2), whereas among males genitourinary tract cancer (n = 245, SR 19.2), especially testicular cancer (n = 187, SR 15.1), was the most frequent. Metastatic disease at diagnosis was already present in 198 patients with a solid cancer (13.3%), whereas 213 (11.5%) developed metastasis in the following years. At 12 months from the diagnosis, 87 of 1488 patients with solid cancers and 35 of 358 patients with hematologic disease failed: overall survival was 94% and 90%, respectively. Patients with a new diagnosis of cancer had produced 6663 hospitalizations, 4640 (69.6%) of which were due to solid tumors, 3992 (59.9%) produced by patients over 29 years old, and 3606 (54.1%) by females. The percentage of day hospital admissions increased proportionally with patient age: 25.7% of all hospitalizations among older adolescents (15–20 years) and 32.9% among young adults of 34–39 years. Conclusions Administrative data have clear advantages in terms of availability and large numbers. Comparison of our results with the literature showed that a health care delivery database can provide useful information for clinical-epidemiologic evaluations in oncology as well as for the analysis of health services utilization.
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Affiliation(s)
- Veronica Scurti
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Sabrina Di Ienno
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Caterina Fanizza
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Maurizio Belfiglio
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Antonio D'ettorre
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Marilena Romero
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
| | - Gianni Tognoni
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (CH), Italy
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Ferrari A. Adolescents with Cancer in Italy: From Local Projects to a National Coordinated Program. TUMORI JOURNAL 2018; 99:e186-7. [DOI: 10.1177/030089161309900431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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31
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Ferrari A, Clerici CA, Casanova M, Luksch R, Terenziani M, Spreafico F, Polastri D, Meazza C, Veneroni L, Catania S, Schiavello E, Biassoni V, Podda M, Massimino M. The Youth Project at the Istituto Nazionale Tumori in Milan. TUMORI JOURNAL 2018; 98:399-407. [DOI: 10.1177/030089161209800401] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The paper describes the key issues of the Youth Project launched in 2011 at the pediatric oncology unit of the Istituto Nazionale Tumori in Milan dedicated to adolescents (over 15 years old) and young adults (up to 25 years old) with solid tumors. The Youth Project was developed within the pediatric oncology unit in the conviction that adolescent patients may benefit from the multidisciplinary team typical of the pediatric oncology setting, as well as the expertise in treating pediatric-type malignancies and enrolling patients in clinical trials. The project was an offshoot of existing activities, making no major changes to the hospital's organization and posing no major demands on the institution's administration and board. Patients are managed by the pediatric oncology staff, but they have access to particular services (e.g., regarding their psychosocial support, fertility preserving measures, access to care after completing therapy); dedicated, adequately equipped multifunctional rooms have been provided. The location of the pediatric unit within a cancer referral center and the cooperation with divisions dedicated to adults have played an important role in the project's creation.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
- Faculty of School of Medicine, Department of Biomolecular Sciences and Biotechnology, Psychology Section, University of Milan, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Daniela Polastri
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
- Faculty of School of Medicine, Department of Biomolecular Sciences and Biotechnology, Psychology Section, University of Milan, Milan, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | | | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
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32
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Hough R, Sandhu S, Khan M, Moran A, Feltbower R, Stiller C, Stevens MCG, Rowntree C, Vora A, McCabe MG. Are survival and mortality rates associated with recruitment to clinical trials in teenage and young adult patients with acute lymphoblastic leukaemia? A retrospective observational analysis in England. BMJ Open 2017; 7:e017052. [PMID: 28982824 PMCID: PMC5639992 DOI: 10.1136/bmjopen-2017-017052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Participation rates in clinical trials are low in teenagers and young adults (TYA) with cancer. Whilst the importance of clinical trials in informing best practice is well established, data regarding individual patient benefit are scarce. We have investigated the association between overall survival and trial recruitment in TYA patients with acute lymphoblastic leukaemia (ALL). DESIGN Retrospective. SETTING National (England) TYA patients treated for ALL. PARTICIPANTS 511 patients aged 15-24 years diagnosed with ALL between 2004 and 2010 inclusive, of whom 239 (46.7%) participated in the UKALL2003 trial. OUTCOME MEASURES Patients were identified using National Clinical Trial (UKALL2003) and Cancer Registry (National Cancer Data Repository, English National Cancer Online Registration Environment) Databases. Relative survival rates were calculated for trial and non-trial patients and observed differences were modelled using a multiple regression approach. The numbers and percentages of deaths in those patients included in the survival analysis were determined for each 3-month period, p values were calculated using the two-tailed z-test for difference between proportions and 95% CIs for percentage deaths were derived using the binomial distribution based on the Wilson Score method. RESULTS Patients treated on the trial had a 17.9% better 2-year survival (85.4% vs 67.5%, p<0.001) and 8.9% better 1-year survival (90.8% vs 81.9%, p=0.004) than those not on the trial. 35 (14.6%) patients recruited to the trial died in the 2 years following diagnosis compared with 86 (32.6%) of those not recruited (p<0.001). CONCLUSIONS TYA patients recruited to the clinical trial UKALL 2003 in England had a lower risk of mortality and a higher overall survival than contemporaneous non-trial patients. These data underline the potential for individual patient benefit in participating in a clinical trial and the importance of international efforts to increase trial participation in the TYA age group. TRIAL REGISTRATION NUMBER ISRCTN07355119.
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Affiliation(s)
| | - Sabrina Sandhu
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Maria Khan
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Anthony Moran
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Richard Feltbower
- Division of Epidemiology & Biostatistics, School of Medicine, University of Leeds, Leeds, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | | | | | - Ajay Vora
- Sheffield Children’s Hospital, Western Bank, London, UK
| | - Martin G McCabe
- Division of Molecular and Clinical Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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33
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Winners' Cup: A National Football Tournament Brings Together Adolescent Patients with Cancer from all over Italy. TUMORI JOURNAL 2017; 103:e25-e29. [DOI: 10.5301/tj.5000655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 11/20/2022]
Abstract
Società Scientifiche Italiane Insieme per gli Adolescenti con Malattie Onco-ematologiche (SIAMO) is an Italian nationwide scheme that focuses on adolescent patients with cancer. Some of its activities include promoting dedicated local projects at the various oncology centers all over the country and organizing events to improve awareness regarding cancer in adolescence. It is with these aims in mind that it organized the Winners' Cup, a football tournament between Italian adolescents who had (or had had) pediatric cancers. There were 144 young people 15 to 24 years old who arrived from 16 different treatment centers around the country to take part in the tournament and share their stories. Such an event had never been attempted before, in Italy at least. The Winners' Cup was a great success and an opportunity to focus attention on the particular clinical, psychological, and social needs of cancer patients in this age group.
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Ferrari A, Trama A, De Paoli A, Bergeron C, Merks JHM, Jenney M, Orbach D, Chisholm JC, Gallego S, Glosli H, De Salvo GL, Botta L, Gatta G, Bisogno G. Access to clinical trials for adolescents with soft tissue sarcomas: Enrollment in European pediatric Soft tissue sarcoma Study Group (EpSSG) protocols. Pediatr Blood Cancer 2017; 64. [PMID: 27882658 DOI: 10.1002/pbc.26348] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/12/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescents with cancer are enrolled in clinical trials at far lower rates than children. This report compares the number of adolescents (15-19-year-olds) and children (0-14-year-olds) enrolled in the protocols of the European pediatric Soft tissue sarcoma Study Group (EpSSG) with the number of cases expected to occur. METHODS The observed-to-expected (O/E) ratio was detected in the EpSSG countries contributing most of the cases, that is, Italy, France, Spain, the Netherlands, United Kingdom, and Ireland. The observed cases included patients enrolled in any of the EpSSG protocols from October 2008 to October 2015, when all EpSSG protocols were open in these countries. The number of expected cases was calculated from the incidence rates estimated throughout the RARECAREnet database in the countries' population-based cancer registries. RESULTS In the countries considered, 2,118 cases aged 0-19 years were enrolled in the EpSSG trials from 2008 to 2015: 82.8% were children and 17.2% were adolescents. The O/E ratio was 0.30 among patients 15-19 years old, as opposed to 0.64 for those 0-14 years old. The O/E ratio differed for the different subtypes: in adolescents, it was 0.64 and 0.18 for rhabdomyosarcoma (RMS) and non-rhabdomyosarcoma soft tissue sarcomas (NRSTS), respectively; in children, it was 0.77 and 0.50, respectively. The O/E ratios differed across the countries considered. CONCLUSIONS Adolescents were less well represented than children on the EpSSG protocols, with better enrolment for RMS than for NRSTS for all age groups.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Annalisa Trama
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Christophe Bergeron
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital-Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - Daniel Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Institut Curie, Paris, France
| | - Julia C Chisholm
- Department of Paediatric Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Soledad Gallego
- Department of Paediatric Oncology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Heidi Glosli
- Department of Pediatrics, University Hospital Oslo, Rikshospitalet, Oslo, Norway
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Laura Botta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gemma Gatta
- Department of Preventive and Predictive Medicine, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Division, Padova University, Padova, Italy
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Comparing Clinical Characteristics and Outcomes of Young-onset and Late-onset Colorectal Cancer: An International Collaborative Study. Clin Colorectal Cancer 2017; 16:334-342. [PMID: 28462853 DOI: 10.1016/j.clcc.2017.03.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 01/26/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Compared with the general population, the incidence of young-onset (YO) colorectal cancer (CRC) is increasing. However, a significant knowledge gap exists in the clinical characteristics, treatment patterns, and outcomes for these patients. MATERIALS AND METHODS Six international tertiary cancer centers conducted a retrospective study. Patients with YO CRC (aged 18-44 years) and LO CRC (aged > 44 years) diagnosed with histologically proven colorectal adenocarcinoma from June 2003 to June 2014 were enrolled. Patients were randomly chosen from each center's database, and the patient demographics and treatment information were collected. The data were then centralized, and the final analysis was performed at a single institution. Cox proportional hazards models were used to estimate the crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for progression-free survival and mortality, and YO was compared with LO. Site-specific HRs were pooled using a random-effects meta-analysis. RESULTS Overall, 498 patients, including 224 with YO (129 men; mean age, 37 ± 5.5 years) and 274 with LO (167 men; mean age, 64.8 ± 9.5 years) CRC, were included. At the diagnosis, 137 patients (61.2%) and 122 patients (44.5%) with YO and LO CRC had metastatic disease, respectively. For both cohorts, the 3 most common presenting symptoms were pain, hematochezia, and weight loss. Surgery was performed in 141 YO (63.0%) and 219 LO (79.9%) patients. The longitudinal noncurative treatment patterns were similar, but more biologic therapy was used for these YO patients. The pooled progression-free survival analysis results for first-line noncurative treatment favored LO (HR, 1.96; 95% CI, 1.04-3.68). The mortality analysis showed no significant differences between the 2 groups (YO: HR, 1.53; 95% CI, 0.91-2.58). CONCLUSION Despite similar treatment patterns and survival outcomes, YO disease might be clinically more aggressive.
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van der Graaf WTA, Orbach D, Judson IR, Ferrari A. Soft tissue sarcomas in adolescents and young adults: a comparison with their paediatric and adult counterparts. Lancet Oncol 2017; 18:e166-e175. [PMID: 28271871 DOI: 10.1016/s1470-2045(17)30099-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Survival outcomes for adolescent and young adult patients with soft tissue sarcomas lag behind those of children diagnosed with histologically similar tumours. To help understand these differences in outcomes, we discuss the following issues with regard to the management of these patients with soft tissue sarcomas: delays in diagnosis, trial availability and participation, aspects of the organisation of care (with an emphasis on age-specific needs), national centralisation of sarcoma care, international consortia, and factors related to tumour biology. Improved understanding of the causes of the survival gap between adolescents and young adults with sarcomas will help drive new initiatives to improve final health outcomes in these populations. In this Review, we specifically focus on embryonal and alveolar rhabdomyosarcoma, synovial sarcoma, and adult soft tissue sarcomas diagnosed in adolescents and young adults, and discuss the age-specific needs of these patients.
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Affiliation(s)
- Winette T A van der Graaf
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Daniel Orbach
- Pediatric, Adolescent and Young Adult Oncology Department, Institut Curie, Paris, France
| | - Ian R Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, UK
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Unger JM, Cook E, Tai E, Bleyer A. The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2017. [PMID: 27249699 DOI: 10.14694/edbk_156686] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
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Affiliation(s)
- Joseph M Unger
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Elise Cook
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Eric Tai
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
| | - Archie Bleyer
- From the Fred Hutchinson Cancer Research Center, Seattle, WA; The University of Texas MD Anderson Cancer Center, Houston, TX; Centers for Disease Control and Prevention, Atlanta, GA; St. Charles Health System, Quality Department, Bend, OR
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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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Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6:20. [PMID: 27891213 PMCID: PMC5109663 DOI: 10.1186/s13569-016-0060-4] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/01/2016] [Indexed: 01/18/2023] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.
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Affiliation(s)
- Adam Dangoor
- Bristol Cancer Institute, Bristol Haematology & Oncology Centre, University Hospitals Bristol NHS Trust, Bristol, BS2 8ED UK
| | - Beatrice Seddon
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Craig Gerrand
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN UK
| | - Robert Grimer
- Royal Orthopaedic Hospital NHS Trust, Birmingham, B31 2AP UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital NHS Trust, London, NW1 2PG UK
| | - Ian Judson
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ UK
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Magni C, Segrè C, Finzi C, Veneroni L, Clerici CA, Massimino M, Casanova M, Martinella V, Chiaravalli S, Ricci A, Biondi A, Ferrari A. Adolescents' Health Awareness and Understanding of Cancer and Tumor Prevention: When and Why an Adolescent Decides to Consult a Physician. Pediatr Blood Cancer 2016; 63:1357-61. [PMID: 27106760 DOI: 10.1002/pbc.25985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/04/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND A feature often seen in adolescent patients with cancer is a lengthy symptom interval, especially in comparison with children. It has been suggested that inadequate awareness of cancer risk among adolescents may play an important role in this study. METHODS The Società Italiana Adolescenti con Malattie Onco-ematologiche and the Fondazione Umberto Veronesi conducted a survey to investigate health awareness among healthy adolescents and their understanding of cancer and its signs and symptoms by commissioning a specialized agency (AstraRicerche). A questionnaire was administered to 500 Italian adolescents from the age group of 15 to 19 years using the computer-aided web interviewing method. RESULTS Approximately 80% of the adolescents interviewed claimed to be well informed about their own health, 85% said they were aware that some lifestyle habits could influence their health, and 80% reported that they know that cancer can develop in adolescence too. It was also noted that, while some adolescents were worried about a given symptom, 22% of them reportedly preferred a wait-and-see approach (either to avoid alarming their parents, or they hoped that the symptom would be temporary). CONCLUSIONS This study showed that a majority of adolescents are concerned about their own health, but sometimes prefer not to report their symptoms to anyone. Hence, it is important to develop information campaigns tailored to raise awareness among this age group and help them interpret their symptoms.
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Affiliation(s)
- Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Biomolecular Sciences and Biotechnology, Psychology Section, Faculty of Medicine, University of Milan, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Angelo Ricci
- Federazione Italiana Associazioni Genitori Oncoematologia Pediatrica, Modena, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM", San Gerardo Hospital, Monza, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Ferrari A, Rondelli R, Pession A, Mascarin M, Buzzoni C, Mosso ML, Maule M, Barisone E, Bertolotti M, Clerici CA, Jankovic M, Fagioli F, Biondi A. Adolescents with Cancer in Italy: Improving Access to National Cooperative Pediatric Oncology Group (AIEOP) Centers. Pediatr Blood Cancer 2016; 63:1116-9. [PMID: 26914476 DOI: 10.1002/pbc.25954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This analysis compared the numbers of patients treated at Italian pediatric oncology group (Associazione Italiana Ematologia Oncologia Pediatrica [AIEOP]) centers with the numbers of cases predicted according to the population-based registry. It considered 32,431 patients registered in the AIEOP database (1989-2012). The ratio of observed (O) to expected (E) cases was 0.79 for children (0-14 years old) and 0.15 for adolescents (15-19 years old). The proportion of adolescents increased significantly over the years, however, from 0.05 in the earliest period to 0.10, 0.18, and then 0.28 in the latest period of observation, suggesting a greater efficacy of local/national programs dedicated to adolescents.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Roberto Rondelli
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli,", University of Bologna, Bologna, Italy
| | - Andrea Pession
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli,", University of Bologna, Bologna, Italy
| | - Maurizio Mascarin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico, Aviano, Italy
| | - Carlotta Buzzoni
- Clinical and Descriptive Epidemiology and Registries Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy
| | - Maria Luisa Mosso
- Childhood Cancer Registry of Piedmont, Department of Medical Sciences, University of Turin, Italy
| | - Milena Maule
- Childhood Cancer Registry of Piedmont, Department of Medical Sciences, University of Turin, Italy
| | - Elena Barisone
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Marina Bertolotti
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Carlo Alfredo Clerici
- Department of Biomolecular Sciences and Biotechnology, Psychology Section, Faculty of Medicine, University of Milan, Milano, Italy
| | - Momcilo Jankovic
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM," San Gerardo Hospital, Monza, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Department and "Tettamanti" Research Centre, Milano-Bicocca University, "Fondazione MBBM," San Gerardo Hospital, Monza, Italy
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Jin SL, Hahn SM, Kim HS, Shin YJ, Kim SH, Lee YS, Lyu CJ, Han JW. Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients. Yonsei Med J 2016; 57:572-9. [PMID: 26996554 PMCID: PMC4800344 DOI: 10.3349/ymj.2016.57.3.572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/29/2015] [Accepted: 09/07/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care. MATERIALS AND METHODS A total of 592 patients aged 0-18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS). RESULTS Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference). CONCLUSION Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs.
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Affiliation(s)
- Song Lee Jin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyo Sun Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Jung Shin
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sun Hee Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Sun Lee
- Department of Pharmacy, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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Pearce S, Brownsdon A, Fern L, Gibson F, Whelan J, Lavender V. The perceptions of teenagers, young adults and professionals in the participation of bone cancer clinical trials. Eur J Cancer Care (Engl) 2016; 27:e12476. [DOI: 10.1111/ecc.12476] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- S. Pearce
- University College London NHS Foundation Trust; London
| | - A. Brownsdon
- Children's and Young People's Cancer Service; University College London Hospitals NHS Foundation Trust; London
| | - L. Fern
- National Cancer Research Institute's Teenage and Young Adult Clinical Studies Group; University College London Hospitals NHS Foundation Trust; London
| | - F. Gibson
- Children and Young People's Cancer Care/Centre for Outcomes and Experiences Research in Children's Health, Illness, and Disability (ORCHID); Great Ormond Street Hospital for Children and London South Bank University; London
| | - J. Whelan
- Department of Oncology; University College London Cancer Institute; University College London Hospitals NHS Foundation Trust; London
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Ferrari A, Lo Vullo S, Giardiello D, Veneroni L, Magni C, Clerici CA, Chiaravalli S, Casanova M, Luksch R, Terenziani M, Spreafico F, Meazza C, Catania S, Schiavello E, Biassoni V, Podda M, Bergamaschi L, Puma N, Massimino M, Mariani L. The Sooner the Better? How Symptom Interval Correlates With Outcome in Children and Adolescents With Solid Tumors: Regression Tree Analysis of the Findings of a Prospective Study. Pediatr Blood Cancer 2016; 63:479-85. [PMID: 26797893 DOI: 10.1002/pbc.25833] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND The potential impact of diagnostic delays on patients' outcomes is a debated issue in pediatric oncology and discordant results have been published so far. We attempted to tackle this issue by analyzing a prospective series of 351 consecutive children and adolescents with solid malignancies using innovative statistical tools. METHODS To address the nonlinear complexity of the association between symptom interval and overall survival (OS), a regression tree algorithm was constructed with sequential binary splitting rules and used to identify homogeneous patient groups vis-à-vis functional relationship between diagnostic delay and OS. RESULTS Three different groups were identified: group A, with localized disease and good prognosis (5-year OS 85.4%); group B, with locally or regionally advanced, or metastatic disease and intermediate prognosis (5-year OS 72.9%), including neuroblastoma, Wilms tumor, non-rhabdomyosarcoma soft tissue sarcoma, and germ cell tumor; and group C, with locally or regionally advanced, or metastatic disease and poor prognosis (5-year OS 45%), including brain tumors, rhabdomyosarcoma, and bone sarcoma. The functional relationship between symptom interval and mortality risk differed between the three subgroups, there being no association in group A (hazard ratio [HR]: 0.96), a positive linear association in group B (HR: 1.48), and a negative linear association in group C (HR: 0.61). CONCLUSIONS Our analysis suggests that at least a subset of patients can benefit from an earlier diagnosis in terms of survival. For others, intrinsic aggressiveness may mask the potential effect of diagnostic delays. Based on these findings, early diagnosis should remain a goal for pediatric cancer patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Giardiello
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Section of Psychology, Department of Biomolecular Sciences and Biotechnology, Faculty of School of Medicine, University of Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Unger JM, Cook E, Tai E, Bleyer A. The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies. Am Soc Clin Oncol Educ Book 2016; 35:185-98. [PMID: 27249699 PMCID: PMC5495113 DOI: 10.1200/edbk_156686] [Citation(s) in RCA: 371] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
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Affiliation(s)
| | - Elise Cook
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Tai
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Archie Bleyer
- St Charles Health System, Quality Department, Bend, Oregon
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Magni C, Veneroni L, Silva M, Casanova M, Chiaravalli S, Massimino M, Clerici CA, Ferrari A. Model of Care for Adolescents and Young Adults with Cancer: The Youth Project in Milan. Front Pediatr 2016; 4:88. [PMID: 27606308 PMCID: PMC4995202 DOI: 10.3389/fped.2016.00088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/09/2016] [Indexed: 01/01/2023] Open
Abstract
Adolescents and young adults (AYA) with cancer form a particular group of patients with unique characteristics, who inhabit a so-called "no man's land" between pediatric and adult services. In the last 10 years, the scientific oncology community has started to pay attention to these patients, implementing dedicated programs. A standardized model of care directed toward patients in this age range has yet to be developed and neither the pediatric nor the adult oncologic systems perfectly fit these patients' needs. The Youth Project of the Istituto Nazionale Tumori in Milan, dedicated to AYA with pediatric-type solid tumors, can be seen as a model of care for AYA patients, with its heterogeneous multidisciplinary staff and close cooperation with adult medical oncologists and surgeons. Further progress in the care of AYA cancer patients is still needed to improve their outcomes.
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Affiliation(s)
- Chiara Magni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Laura Veneroni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Hemato-Oncology, University of Milan, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milan , Italy
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Aristizabal P, Singer J, Cooper R, Wells KJ, Nodora J, Milburn M, Gahagan S, Schiff DE, Martinez ME. Participation in pediatric oncology research protocols: Racial/ethnic, language and age-based disparities. Pediatr Blood Cancer 2015; 62:1337-44. [PMID: 25755225 PMCID: PMC4482802 DOI: 10.1002/pbc.25472] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Survival rates in pediatric oncology have improved dramatically, in part due to high patient participation in clinical trials. Although racial/ethnic inequalities in clinical trial participation have been reported in adults, pediatric data and studies comparing participation rates by socio-demographic characteristics are scarce. The goal of this study was to assess differences in research protocol participation for childhood cancer by age, sex, race/ethnicity, parental language, cancer type, and insurance status. PROCEDURE Data on enrollment in any protocol, biospecimen, or therapeutic protocols were collected and analyzed for newly diagnosed pediatric patients with cancer from 2008-2012 at Rady Children's Hospital. RESULTS Among the 353 patients included in the analysis, 304 (86.1%) were enrolled in any protocol. Enrollment in biospecimen and therapeutic protocols was 84.2% (261/310) and 81.1% (206/254), respectively. Logistic regression analyzes revealed significant enrollment underrepresentation in any protocol for Hispanics compared to Non-Hispanic whites (81% vs. 91%; Odds Ratio [OR], 0.43; 95% Confidence Interval [CI], 0.21-0.90; P = 0.021) and among children of Spanish-speaking vs. English-speaking parents (78% vs. 89%; OR, 0.45; 95%CI, 0.23-0.87; P = 0.016). Compared to patients aged 0-4 years, significant underrepresentation was also found among patients 15-21 years old (92% vs.72%; OR, 0.21; 95% CI, 0.09-0.48; P < 0.001). Similar trends were observed when analyzing enrollment in biospecimen and therapeutic protocols separately. CONCLUSIONS There was significant underrepresentation in protocol participation for Hispanics, children of Spanish-speaking parents, and patients ages 15-21. Research is needed to understand barriers to research participation among these groups underrepresented in pediatric oncology clinical trials.
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Affiliation(s)
- Paula Aristizabal
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Jenelle Singer
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Renee Cooper
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Kristen J. Wells
- Department of Psychology, San Diego State University, San Diego, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Jesse Nodora
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Mehrzad Milburn
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Sheila Gahagan
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA
| | - Deborah E. Schiff
- Department of Pediatrics, University of California San Diego, San Diego, CA,Division of Pediatric Hematology/Oncology, Rady Children’s Hospital San Diego, San Diego, CA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
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Weiss AR, Hayes-Lattin B, Kutny MA, Stock W, Stegenga K, Freyer DR. Inclusion of Adolescents and Young Adults in Cancer Clinical Trials. Semin Oncol Nurs 2015; 31:197-205. [PMID: 26210198 PMCID: PMC5520996 DOI: 10.1016/j.soncn.2015.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To discuss recent and current initiatives to increase enrollment of adolescents and young adult (AYA) cancer patients onto National Cancer Institute-funded clinical trials to improve outcomes. DATA SOURCES Peer-reviewed publications, websites of professional organizations. CONCLUSION Despite many challenges facing AYAs, recent studies illustrate that AYA-focused cancer clinical trials can be successfully developed and conducted. Development of the National Cancer Institute National Clinical Trials Network and related AYA-focused initiatives create new opportunities to expand clinical trials that serve AYAs. IMPLICATIONS FOR NURSING PRACTICE Nurses can influence AYA outcomes by leveraging their roles as educators and collaborators to increase participation in cancer clinical trials.
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Affiliation(s)
- Aaron R. Weiss
- Maine Children’s Cancer Program, Division of Pediatric Hematology-Oncology, Maine Medical Center, Portland, ME
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Matthew A. Kutny
- Department of Pediatrics, Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Wendy Stock
- University of Chicago Department of Medicine, Section of Hematology–Oncology and University of Chicago Comprehensive Cancer Center Chicago, IL
| | | | - David R. Freyer
- Children’s Center for Cancer and Blood Disorders, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA
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