Search

There is a substantial difference in observed survival among children with acute lymphoblastic leukemia in high‐income countries versus those in low‐ and middle‐income countries. This gap can be reduced considerably by multilevel investing in health systems and services with innovative frameworks such as implementation science. [ABSTRACT FROM AUTHOR]

Purpose: In the absence of a standardized tool to assess the quality of pediatric hematology/oncology training programs, the Education Program Assessment Tool (EPAT) was conceptualized as a user‐friendly and adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for training programs around the world. Methods: The development of EPAT consisted of three main phases: operationalization, consensus, and piloting. After each phase, the tool was iteratively modified based on feedback to improve its relevance, usability, and clarity. Results: The operationalization process led to the development of 10 domains with associated assessment questions. The two‐step consensus phase included an internal consensus phase to validate the domains and a subsequent external consensus phase to refine the domains and overall function of the tool. EPAT domains for programmatic evaluation are hospital infrastructure, patient care, education infrastructure, program basics, clinical exposure, theory, research, evaluation, educational culture, and graduate impact. EPAT was piloted in five training programs in five countries, representing diverse medical training and patient care contexts for proper validation of the tool. Face validity was confirmed by a correlation between the perceived and calculated scores for each domain (r = 0.78, p <.0001). Conclusions: EPAT was developed following a systematic approach, ultimately leading to a relevant tool to evaluate the different core elements of pediatric hematology/oncology training programs across the world. With EPAT, programs will have a tool to quantitatively evaluate their training, allowing for benchmarking with centers at the local, regional, and international level. The Education Program Assessment Tool (EPAT) is an adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for pediatric hematology/oncology fellowship programs around the world. This tool was developed following a systematic approach, ultimately leading to a relevant tool to quantitatively evaluate programs and their training, allowing for benchmarking with centers at the local, regional, and international levels. [ABSTRACT FROM AUTHOR]

Cancer types in adolescents and young adults form a unique distribution. A system for classifying them is presented. [ABSTRACT FROM AUTHOR]

Background: Recent observations suggest that prostate cancer is an increasing disease among older adolescents and young adults.Methods: Incidence, mortality, and survival data were obtained from the US National Cancer Institute Surveillance, Epidemiology, and End Results program and the Institute for Health Metrics and Evaluation Global Burden of Disease database.Results: Worldwide, the incidence of prostate cancer has increased in all groups between ages 15 and 40 years and increased globally at a steady rate averaging 2% per year since 1990 (P < .01). In the United States, this age group was >6 times more likely than older men to have distant disease at diagnosis. Stage for stage, their survival rate improved less than in older men. Whereas the overall 5-year relative survival rate in the United States for men diagnosed between ages 40 and 80 years was between 95% and 100%, it was 30% in those aged 15 to 24 years, 50% in those aged 20 to 29 years, and 80% in those aged 25 to 34 years.Conclusions: Prostate cancer in older adolescent and young adult men has increased in most countries. There is some evidence that this may be caused in part by underdiagnosis, prostate-specific antigen screening, and overdiagnosis. It also may be caused by trends in obesity, physical inactivity, HPV infection, substance exposure, environmental carcinogens, and/or referral patterns. How the biology of these cancers differs from that in older men and how the etiologies vary from country to country remain to be determined. [ABSTRACT FROM AUTHOR]

While meeting conventional thresholds for cost‐effectiveness, the care of children with cancer in low and middle‐income countries is compromised by limited access to affordable medicines of high quality. Survival prospects are constrained further by high rates of abandonment of therapy, which are linked to socioeconomic disadvantage and the financial toxicity experienced by families in the care of their children with malignant disease. [ABSTRACT FROM AUTHOR]

Background: The late effects of treatment for acute lymphoblastic leukemia (ALL) include disordered body composition, especially obesity. Less attention has been focused on the loss of skeletal muscle mass (SMM) and the combined morbidity of sarcopenic obesity.Methods: A cross-sectional study of body composition was undertaken via dual-energy x-ray absorptiometry in 75 long-term survivors of ALL (more than 10 years after the diagnosis). Measures were obtained of the fat mass (FM), fat-free mass (equivalent to the lean body mass [LBM]), and whole-body bone mineral content. Health-related quality of life (HRQL) was measured with the Health Utilities Index.Results: The sum of the FM, LBM, and whole-body bone mineral content matched the total body weight measured directly (r = 0.998). The appendicular lean mass (ALM) was derived from the LBM in all 4 limbs and accounted for approximately 75% of the SMM. According to the fat mass index (FMI; ie, FM/height2 ), 12% of females and 18% of males were frankly obese by World Health Organization criteria. The median FMI z score was + 0.40, whereas the median z score for the appendicular lean mass index (ALMI; ie, ALM/height2 ) was -0.40. Sarcopenic obesity, defined as a positive FMI z score with a negative ALMI z score, was present in 32 subjects (43%). There were statistically significant and clinically important differences in overall HRQL between subjects with and without sarcopenic obesity.Conclusions: Sarcopenic obesity is prevalent in long-term survivors of ALL, and this places them in double jeopardy from excess body fat and inadequate SMM (eg, a combination of metabolic and frailty syndromes). It is associated with an adverse impact on overall HRQL. Cancer 2018;124:1225-31. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Incidence rates and trends of cancers in adolescents and young adults (AYAs) ages 15 to 39 years were reexamined a decade after the US National Cancer Institute AYA Oncology Progress Review Group was established.Methods: Data from the Surveillance, Epidemiology, and End Results program through 2011 were used to ascertain incidence trends since the year 2000 of the 40 most frequent cancers in AYAs, including tumors with nonmalignant/noninvasive behavior.Results: Seven cancers in AYAs exhibited an overall increase in incidence; in 4, the annual percent change (APC) exceeded 3 (kidney, thyroid, uterus [corpus], and prostate cancer); whereas, in 3, the APC was between 0.7 and 1.4 (acute lymphoblastic leukemia and cancers of the colorectum and testis). Eight cancers exhibited statistically significant decreases in incidence among AYAs: Kaposi sarcoma (KS), fibromatous neoplasms, melanoma, and cancers of the anorectum, bladder, uterine cervix, esophagus, and lung, each with an APC less than -1. AYAs had a higher proportion of noninvasive tumors than either older or younger patients.Conclusions: An examination of cancer incidence patterns in AYAs observed over the recent decade reveal a complex pattern. Thyroid cancer by itself accounts for most of the overall increase and is likely caused by overdiagnosis. Reductions in cervix and lung cancer, melanoma, and KS can be attributed to successful national prevention programs. A higher proportion of noninvasive tumors in AYAs than in children and older adults indicates a need to revise the current system of classifying tumors in this population. [ABSTRACT FROM AUTHOR]

Background: With prior reports indicating a lack of progress in survival improvement in older adolescents and young adults (AYAs) aged 15 to 39 years with cancer compared with both younger and older patients with cancer, the current analysis provides an update of survival trends of cancers among AYAs, children, and older adults.Methods: Data from the National Cancer Institute Surveillance, Epidemiology, and End Results database for 13 regions were used to ascertain survival trends of the 34 most frequent cancers diagnosed in AYAs compared with children and older adults.Results: As of 2002 through 2006, the 5-year relative survival rate for all invasive cancers in AYAs was 82.5% (standard error, 0.2%). In AYAs, 14 cancers demonstrated evidence of a statistically significant improvement in their 5-year relative survival since 1992. Survival improved less in AYAs than in children for acute myeloid leukemia and medulloblastoma. Fourteen cancers had survival improvements that were found to be less in AYAs compared with older adults, including hepatic carcinoma, acute myeloid leukemia, high-grade astrocytoma, acute lymphocytic leukemia, pancreatic carcinoma, low-grade astrocytoma, gastric carcinoma, renal carcinoma, cancer of the oral cavity and pharynx, Hodgkin lymphoma, ovarian cancer, fibromatous sarcoma, other soft tissue sarcoma, and thyroid carcinoma.Conclusions: Improvements in the survival of several cancer types that occur frequently in AYAs are encouraging. However, survival does not appear to be improving to the same extent in AYAs as in children or older adults for several cancers. Further investment in exploring the distinct biology of tumors in this age group, and of their hosts, must be a priority in AYA oncology. [ABSTRACT FROM AUTHOR]

BACKGROUND The percentage of adolescent and young adult (AYA) patients with cancer (those aged 15-39 years) diagnosed at a distant stage of disease did not significantly change between 1975 and 2004. It has been hypothesized that a lack of health insurance may be a significant risk factor for a diagnosis of distant-stage disease among AYA patients, but to the authors' knowledge this has not been examined in a national sample. METHODS The National Cancer Data Base, a hospital-based cancer registry, was used to obtain data regarding incident cancer cases among patients aged 15 years to 39 years who were diagnosed between 2004 and 2010. After all exclusions, a total of 285,448 cases were available for analysis; all AYA cancer sites were included. A retrospective study was conducted to assess the association between insurance status and stage of disease at diagnosis. RESULTS After adjusting for age, race/ethnicity, facility type, ZIP code-based income and education levels, and US Census region, it was found that among males, uninsured patients were 1.51 times more likely to be diagnosed at a distant stage of disease compared with patients with private insurance (95% confidence interval, 1.46-1.55). Among females, the effect of insurance was stronger, with uninsured patients found to be 1.86 times more likely to be diagnosed at a distant stage (95% confidence interval, 1.79-1.94). The effect of insurance status was substantially stronger for malignancies that are more amenable to early detection (melanoma, thyroid carcinoma, breast carcinoma, genitourinary carcinoma), and substantially weaker for those that are less amenable to early detection (lung carcinoma, adrenocortical carcinoma, Wilms tumor). CONCLUSIONS In a large national sample of AYA patients with cancer, insurance status was found to be a strong independent risk factor for distant-stage disease at the time of diagnosis. Cancer 2014;120:1212-1219. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Cancer in adolescents and young adults is an important public health issue, because there are approximately 1 million new cases annually. The distribution of diseases in this age group varies geographically, contributing to differences in survival rates. Although an overall survival rate exceeding 80 % has been reported in optimal circumstances, emerging knowledge about distinctions in tumor biology and enhanced clinical accrual to clinical trials should lead to further gains. The challenges of cancer survivorship demand further attention with a particular focus on the quality of life of survivors and amelioration of the long-term complications of treatment. Programs in cancer screening and prevention provide potential for considerable benefits in this age group. A renewed perspective on the adolescent and young adult cohort is required; and, in all of these opportunities for change, there are important roles to be played by advocacy groups internationally. Cancer 2011;117(10 suppl):2245-9. © 2011 American Cancer Society. Cancer in adolescents and young adults is a global health concern with opportunities for gains in the areas of tumor biology, clinical trial accrual, screening/prevention, and survivorship. Advocacy groups can play a prominent role as agents of change. [ABSTRACT FROM AUTHOR]

Adolescents and young adults (AYA) with advanced or terminal cancer have distinctive medical and psychosocial needs that may not have been adequately provided by either pediatric or adult palliative care services. A discussion group, as part of a larger workshop on AYA with cancer, was held in Toronto on March 11-13, 2010;117:-. Recommendations were as follows: Develop a specific AYA screening tool designed to detect increased anxiety or new symptoms and to initiate discussion about palliative or symptom care; Set Canadian standards for palliative care in AYA patients. These standards should be included in hospital accreditation; Involve the palliative/symptom care team early in the disease trajectory to help manage clinically important symptoms that may not be associated with imminent death; Establish specific AYA multidisciplinary palliative care teams throughout Canada that are flexible and can work in both pediatric and adult facilities, and are able to work in a 'virtual' environment to support patients being cared for at home; Improve physical facilities in hospices and hospitals to meet the distinctive needs of terminally ill AYA patients; Enhance support for palliative care at home by: changing legislation to improve Compassionate Care Benefits and developing 'virtual palliative care support teams'. Adequate provision of AYA palliative care and symptom management services will likely confer notable benefits to AYA patients and their families, and is likely to be cost saving to the tax payer by avoiding prolonged hospitalization and promoting easier return to work for the families and caregivers. Cancer 2011;117(10 suppl):2323-8. © 2011 American Cancer Society. Adolescents and young adults with advanced or terminal cancer had distinct needs that may not have been provided in either a pediatric or adult palliative care setting. Recommendations were suggested for improvements in provision of palliative and symptom care for this age group. [ABSTRACT FROM AUTHOR]

The article reports on the study which compared the correlation of proxy reporting of health-related quality of life (HRQL) by the parents and nurses of children with Hodgkin disease. It indicates that the Canadian children's Pediatric Quality of Life Inventory (PedsQL) generic scores increased at the end of the study except during inpatient chemotherapy. It implies that nurses contributed valuable information as proxy respondents regarding the quality of life for children with Hodgkin disease.

The article presents a cost-effectiveness study which compares amputation to limb salvage. Researchers found that endoprosthetic replacements are expected to gradually fail and that most young and active people will demand the use of a sophisticated artificial limb. It is noted that a successful limb salvage surgery cannot be assumed particularly in young people with bone and soft tissue sarcomas of the lower limb.

The article presents a study which examined the efficacy and utilization of sperm banking for preservation of male fertility in adolescents and young adults (AYA) with cancer. The results of the study showed that patients who used their cryopreserved semen for attempted conception had a 36.4% success rate with intrauterine insemination (IUI) and a 50.0% clinical pregnancy rate with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

An introduction to the journal, which featured articles from the presentations at the International Workshop on Adolescents and Young Adults With Cancer: Towards Better Outcomes in Canada, is presented.

As is increasingly being recognized, the needs of adolescents and young adults (AYA) with cancer are poorly met met by the conventional dichotomy of the pediatric and adult health care systems, resulting in delays in diagnosis, low participation rates in clinical trials, lack of age-appropriate care, concerns about social support during therapy, and long-term psychosocial and other challenges in survivorship. It is the authors' firm belief that the deliberations at the workshop and its attendant activities will be informative and useful for colleagues beyond Canada as the network of communication in AYA oncology continues to grow. [ABSTRACT FROM AUTHOR]