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Kubicek P, Cesne AL, Lervat C, Toulmonde M, Chevreau C, Duffaud F, Le Nail LR, Morelle M, Gaspar N, Vérité C, Castex MP, Penel N, Saada E, Causeret S, Bertucci F, Perrin C, Bompas E, Orbach D, Laurence V, Piperno-Neumann S, Anract P, Rios M, Gentet JC, Mascard É, Pannier S, Blouin P, Carrère S, Chaigneau L, Soibinet-Oudot P, Corradini N, Boudou-Rouquette P, Ruzic JC, Lebrun-Ly V, Dubray-Longeras P, Varatharajah S, Lebbe C, Ropars M, Kurtz JE, Guillemet C, Lotz JP, Berchoud J, Cherrier G, Ducimetière F, Chemin C, Italiano A, Honoré C, Desandes E, Blay JY, Gouin F, Marec-Bérard P. Management and outcomes of adolescent and young adult sarcoma patients: results from the French nationwide database NETSARC. BMC Cancer 2023; 23:69. [PMID: 36670431 PMCID: PMC9854049 DOI: 10.1186/s12885-023-10556-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The initial management of patients with sarcoma is a critical issue. We used the nationwide French National Cancer Institute-funded prospective sarcoma database NETSARC to report the management and oncologic outcomes in adolescents and young adults (AYAs) patients with sarcoma at the national level. PATIENTS AND METHODS NETSARC database gathers regularly monitored and updated data from patients with sarcoma. NETSARC was queried for patients (15-30 years) with sarcoma diagnosed from 2010 to 2017 for whom tumor resection had been performed. We reported management, locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) in AYA treated in French reference sarcoma centers (RSC) and outside RSC (non-RSC) and conducted multivariable survival analyses adjusted for classical prognostic factors. RESULTS Among 3,227 patients aged 15-30 years with sarcoma diagnosed between 2010 and 2017, the study included 2,227 patients with surgery data available, among whom 1,290 AYAs had been operated in RSC, and 937 AYAs in non-RSC. Significant differences in compliance to guidelines were observed including pre-treatment biopsy (RSC: 85.9%; non-RSC 48.1%), pre-treatment imaging (RSC: 86.8%; non-RSC: 56.5%) and R0 margins (RSC 57.6%; non-RSC: 20.2%) (p < 0.001). 3y-OS rates were 81.1% (95%CI 78.3-83.6) in AYA in RSC and 82.7% (95%CI 79.4-85.5) in AYA in non-RSC, respectively. Whereas no significant differences in OS was observed in AYAs treated in RSC and in non-RSC, LRFS and PFS were improved in AYAs treated in RSC compared to AYAs treated in non-RSC (Hazard Ratios (HR): 0.58 and 0.83, respectively). CONCLUSIONS This study highlights the importance for AYA patients with sarcoma to be managed in national sarcoma reference centers involving multidisciplinary medical teams with paediatric and adult oncologists.
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Affiliation(s)
- Pierre Kubicek
- grid.418191.40000 0000 9437 3027Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Angers, France ,grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Axel Le Cesne
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Cyril Lervat
- grid.452351.40000 0001 0131 6312Centre Oscar Lambret, Lille, France
| | - Maud Toulmonde
- grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | - Christine Chevreau
- grid.417829.10000 0000 9680 0846Institut Claudius Régaud IUCT Toulouse, Toulouse, France
| | | | | | - Magali Morelle
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Nathalie Gaspar
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Cécile Vérité
- grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | | | - Nicolas Penel
- grid.452351.40000 0001 0131 6312Centre Oscar Lambret, Lille, France
| | - Esma Saada
- grid.417812.90000 0004 0639 1794Centre Antoine Lacassagne, Nice, France
| | - Sylvain Causeret
- grid.418037.90000 0004 0641 1257Centre Georges François Leclerc, Dijon, France
| | - François Bertucci
- grid.418443.e0000 0004 0598 4440Institut Paoli-Calmettes, Marseille, France
| | - Christophe Perrin
- grid.417988.b0000 0000 9503 7068Centre Eugène Marquis, Rennes, France
| | - Emmanuelle Bompas
- grid.418191.40000 0000 9437 3027Institut de Cancérologie de l’Ouest, Nantes, France
| | - Daniel Orbach
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Valérie Laurence
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Sophie Piperno-Neumann
- grid.418596.70000 0004 0639 6384SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Philippe Anract
- grid.411784.f0000 0001 0274 3893Hôpital Cochin, Paris, France
| | - Maria Rios
- grid.452436.20000 0000 8775 4825Institut de Cancérologie de Lorraine, Nancy, France
| | | | - Éric Mascard
- grid.412134.10000 0004 0593 9113Hôpital Necker, Paris, France
| | | | - Pascale Blouin
- grid.411777.30000 0004 1765 1563CHU Tours, Tours, France
| | - Sébastien Carrère
- grid.418189.d0000 0001 2175 1768Centre Val d’Aurelle ICM, Montpellier, France
| | - Loïc Chaigneau
- grid.411158.80000 0004 0638 9213CHU Besançon, Besançon, France
| | | | | | | | | | | | | | | | - Céleste Lebbe
- grid.413328.f0000 0001 2300 6614Hôpital Saint-Louis, Paris, France
| | - Mickaël Ropars
- grid.411154.40000 0001 2175 0984CHU Rennes, Rennes, France
| | - Jean-Emmanuel Kurtz
- grid.512000.6Institut de Cancérologie Strasbourg-Europe ICANS, Strasbourg, France
| | - Cécile Guillemet
- grid.418189.d0000 0001 2175 1768Centre Henri Becquerel, Rouen, France
| | | | | | | | | | - Claire Chemin
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - Antoine Italiano
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France ,grid.476460.70000 0004 0639 0505Institut Bergonié, Bordeaux, France
| | - Charles Honoré
- grid.14925.3b0000 0001 2284 9388Gustave Roussy, Villejuif, France
| | - Emmanuel Desandes
- CHRU Nancy, Centre de Recherche en Epidémiologie et en Statistique Sorbonne-Paris Cité (CRESS), UMR 1153, INSERM, Université de Paris-Descartes, Paris, France
| | - Jean-Yves Blay
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France
| | - François Gouin
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France ,grid.277151.70000 0004 0472 0371CHU Nantes, Nantes, France
| | - Perrine Marec-Bérard
- grid.418116.b0000 0001 0200 3174Centre Léon Bérard, Lyon, France ,Institute of Pediatric Hematology and Oncology, Lyon, France
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Clinical management of adolescents and young adults suffering from sarcoma in the French Rhône-Alpes region: A prospective exhaustive cohort with 10 years follow up. Eur J Surg Oncol 2020; 46:1301-1309. [PMID: 32334938 DOI: 10.1016/j.ejso.2020.03.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Survival of adolescents and young adults (AYA) with sarcoma is lower than in younger patients. The objective of this study was to describe the regional healthcare circuits, the differences in the management between adult, paediatric and mixed units and to assess the prognostic impact of compliance with clinical practice guidelines (CPGs) on overall survival (OS) and on relapse free survival (RFS). MATERIALS AND METHODS Retrospective analysis of the management and long term follow-up of all 13-25 year old patients with a sarcoma diagnosed in the Rhône-Alpes area between 2000 and 2005. RESULTS 140 patients satisfied inclusion criteria and were selected. The majority of 13-25 year old patients were treated in paediatric units. Joint management resulted in a higher rate of discussion in multidisciplinary tumour board, inclusion in clinical trials, and fertility preservation. Non-compliance with guidelines was observed in 65% of cases. Overall compliance was not reported to correlate to survival. Compliance of radiotherapy with CPG's seemed associated with a better prognosis for OS (HR = 0.20, 95% CI = [0.10-0.40]; p < 0.0001) and RFS (HR = 0.18, 95% CI = [0.09-0.37; p < 0.0001) as well as compliance of surgery for OS (HR = 0.43, 95% CI = [0.23-0.81]; p = 0.01). Multivariate Cox regression analysis revealed other independent predictors of OS like age at diagnosis, stage and histological subtype. CONCLUSIONS Management of AYA in joint units seems to improve the quality of care. Compliance of surgery and radiotherapy with CGP's seems to improve survival.
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Desandes E, Brugières L, Molinié F, Defossez G, Delafosse P, Jehannin-Ligier K, Velten M, Trétarre B, Amadéo B, Marrer E, Woronoff AS, Ganry O, Monnereau A, d'Almeida T, Troussard X, Daubisse-Marliac L, Bara S, Guizard AV, Baldi I, Launoy G, Clavel J, Lacour B. Adolescent and young adult oncology patients in France: Heterogeneity in pathways of care. Pediatr Blood Cancer 2018; 65:e27235. [PMID: 29770995 DOI: 10.1002/pbc.27235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND In order to evaluate at the population level the impact of the actions developed in France since 2004 to organize the care of adolescents and young adults (AYAs) with cancer, we conducted the present study to provide an unbiased view of the pathway of care of these patients. METHODS Using a population-based registry, we conducted a review of all cases of cancer diagnosed during 2012 and 2013 in 15- to 24-year-old patients living in nineteen French administrative areas. RESULTS The median times for diagnosis and treatment of the 993 included AYAs were 9 weeks (3-22) and 1 day (0-20), respectively. Delays in diagnosis were significantly longer in young adults than in adolescents, especially for soft-tissue sarcomas (48.7 weeks vs. 15.4 weeks, P = 0.04) and bone tumors (21.4 weeks vs. 10.1 weeks, P = 0.04). The first physicians seen by patients were mostly general practitioners (67.4%). Most patients (77.5%) were treated in adult units. Management decisions were taken within the context of a multidisciplinary team (MDT) in 85.3% of cases. MDT meetings that involved both pediatric and adult oncologists were uncommon (15.7% of patients). Twenty-six percent of patients were included in randomized or nonrandomized clinical studies. The proportion of inclusion was significantly higher in adolescents (39.5%) than in young adults (16.8%). CONCLUSION In France, pathways of care for AYAs are heterogeneous. It is necessary to organize a national network of expert centers with adequate medical skills and specific psychosocial support and facilities to provide the best possible care for these patients.
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Affiliation(s)
- Emmanuel Desandes
- CHRU Nancy, Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, Vandœuvre-lès-Nancy, France.,Université Paris-Sorbonne, CRESS équipe7, Inserm UMRS-1153, Paris, France
| | - Laurence Brugières
- Gustave Roussy Cancer Campus, Département de Cancérologie de l'Enfant et de l'Adolescent, Villejuif, France
| | - Florence Molinié
- Registre des cancers de Loire-Atlantique et Vendée, Nantes, France
| | - Gautier Defossez
- Registre Général des Cancers de Poitou-Charentes, CHU Poitiers, Poitiers, France
| | - Patricia Delafosse
- Registre du cancer du département de l'Isère, CHU Grenoble, Grenoble, France
| | | | - Michel Velten
- Université de Strasbourg, Inserm IRFAC UMR-S 1113, Registre des cancers du Bas-Rhin, Strasbourg, France
| | - Brigitte Trétarre
- Institut du Cancer de Montpellier, Registre des tumeurs de l'Hérault, Montpellier, France
| | - Brice Amadéo
- Université de Bordeaux, Inserm U1219, ISPED, Registre des cancers de la Gironde, Bordeaux, France
| | - Emilie Marrer
- Groupe hospitalier de Mulhouse et Sud Alsace (GHRMSA), Registre des cancers du Haut-Rhin, Mulhouse, France
| | - Anne-Sophie Woronoff
- CHRU Besançon, Registre des tumeurs du Doubs et du Territoire de Belfort - EA3181, Besançon, France
| | - Olivier Ganry
- CHRU Amiens, Registre du cancer de la Somme, Amiens, France
| | - Alain Monnereau
- Institut Bergonié, Registre des Hémopathies Malignes de la Gironde, Bordeaux, France
| | - Tania d'Almeida
- CHU Limoges, Registre Général des Cancers de la Haute-Vienne, Limoges, France
| | - Xavier Troussard
- CHU Caen, Université Caen Normandie, Registre Régional des Hémopathies Malignes de Basse Normandie, Caen, France
| | - Laetitia Daubisse-Marliac
- Institut Claudius Regaud, IUCT-O, Registre des cancers du Tarn, Toulouse, France; CHU Toulouse, France; UMR 1027 Université de Toulouse, UPS, Inserm, Toulouse, France
| | - Simona Bara
- Centre Hospitalier Cherbourg Public du Cotentin, Registre des cancers de la Manche, Cherbourg-Octeville -en-Cotentin, Cherbourg, France
| | - Anne-Valérie Guizard
- Centre François Baclesse, Registre Général des Tumeurs du Calvados, U1086 INSERM, UCBN, Caen, France
| | - Isabelle Baldi
- Université de Bordeaux, Inserm U1219, ISPED, Registre des Tumeurs du système nerveux central de Gironde, Bordeaux, France
| | - Guy Launoy
- Université de Caen, U 1086 Inserm, Registre des tumeurs digestives du Calvados, Caen, France
| | - Jacqueline Clavel
- Université Paris-Sorbonne, CRESS équipe7, Inserm UMRS-1153, Paris, France.,Registre National des cancers de l'Enfant, Registre National des hémopathies malignes de l'Enfant, Villejuif, France
| | - Brigitte Lacour
- CHRU Nancy, Registre National des cancers de l'Enfant, Registre National des Tumeurs Solides de l'Enfant, Vandœuvre-lès-Nancy, France.,Université Paris-Sorbonne, CRESS équipe7, Inserm UMRS-1153, Paris, France
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Desandes E, Brugieres L, Laurence V, Berger C, Kanold J, Tron I, Clavel J, Lacour B. Survival of adolescents with cancer treated at pediatric versus adult oncology treatment centers in France. Pediatr Blood Cancer 2017; 64. [PMID: 27860291 DOI: 10.1002/pbc.26326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND In France, although children aged less than 15 years with cancer are usually referred to pediatric oncology centers, adolescents may be treated at pediatric or adult oncology centers. The objective was to compare survival according to their site of treatment. PROCEDURE Using population-based registration, 15- to 19-year-old patients diagnosed with cancer in 2006 or 2007 and living in six French regions (accounting for 41% of the French population) were included. RESULTS Of the 594 patients included, 33% of the French adolescents were treated at a pediatric oncology center. Compared with those treated at a pediatric center, adolescents treated at an adult center were older, were more likely to have carcinoma and germ-cell tumor, had a longer time to diagnosis, and were less likely to be enrolled in a clinical trial. In addition, the decisions for their management were less likely to be taken in the context of multidisciplinary team meetings. In multivariate analysis, adolescent patients treated at a pediatric center did not have significantly different overall survival (OS) compared with those treated at an adult center (5-year OS: 84.1% [95% confidence interval: 78.6-90.0] versus 87.7% [95% confidence interval: 84.2-91.3]; P = 0.25). CONCLUSIONS The outcomes of French adolescents with cancer have begun to improve, with 81.2% survival in 2006-2007, with no difference between the types of treatment center. However, for this unique group of diseases, survival is not the unique endpoint. In order to ensure good quality of life after cancer, management of those patients requires specific approaches, designed to reduce the late effects of cancer treatment and improve supportive care.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
| | - Laurence Brugieres
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France
| | | | - Claire Berger
- Rhône-Alpes Childhood Cancer Registry, University Hospital Centre of St-Etienne, St-Etienne, France
| | - Justyna Kanold
- Childhood Cancer Registry of Auvergne/Limousin, Inserm CIC 501, University Hospital Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Tron
- Childhood Cancer Registry of Bretagne, ORS Rennes, Rennes, France
| | - Jacqueline Clavel
- Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France.,French National Registry of Childhood Cancer-French National Registry of Childhood Hematological Malignancies, Villejuif, France
| | - Brigitte Lacour
- French National Registry of Childhood Cancer-French National Registry of Childhood Solid Tumors, University Hospital Centre of Nancy, Vandoeuvre-lès-Nancy, France.,Inserm UMRS-1153, CRESS team 7, University of Paris-Sorbonne, Paris, France
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Jones LJ, Pini SA, Morgan SJ, Birk GK, Stark DP. How Do Teenagers and Young Adults with Cancer Experience Their Care? A European Survey. J Adolesc Young Adult Oncol 2017; 6:102-110. [DOI: 10.1089/jayao.2016.0011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Lucy J.W. Jones
- Leeds Teaching Hospital Trust, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Simon A. Pini
- The Psychosocial Research Group, University of Leeds, Leeds, United Kingdom
| | - Sue J. Morgan
- Leeds Teaching Hospital Trust, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Gurpreet K. Birk
- Leeds Teaching Hospital Trust, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Dan P. Stark
- Leeds Teaching Hospital Trust, St. James's Institute of Oncology, Leeds, United Kingdom
- The Psychosocial Research Group, University of Leeds, Leeds, United Kingdom
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Desandes E, Lacour B, Clavel J. [Cancer in adolescents and young adults in France: Epidemiology and pathways of care]. Bull Cancer 2016; 103:957-965. [PMID: 27817857 DOI: 10.1016/j.bulcan.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 09/30/2016] [Indexed: 11/15/2022]
Abstract
In adolescents and young adults (AYA), cancers are rare but represent the third significant cause of death. The aim of this paper was to investigate epidemiological data and pathways of care of AYA in France. During the 2000-2008 period, overall age-standardized incidence rates (ASR) were 254.1/106 in 15-24-year-olds. The most frequently diagnosed cancers in male AYA were malignant gonadal germ-cell tumors and Hodgkin's lymphoma, and were melanoma, thyroid carcinoma and Hodgkin's disease in females. The ASR appeared stable over time. During the 2000-2004 period, the 5-year overall survival for all cancers was 81.8%, with differences between genders and age groups: 78.8% for males and 85.2% for females; 78.5% in 15-19-year-olds and 84.3% in 20-24-year-olds. Survival has significantly improved over time. During the 2006-2007 period, the pathways of care for French adolescent patients with cancer were heterogeneous: 82% were treated in an adult environment, 27% were included in clinical studies, and in 54% of cases the management decisions were taken in the context of a multidisciplinary team. Studies looking at management of AYA with cancer have shown a wide disparity and a lack of collaboration between adult oncologists and pediatric oncologist. An AYA cancer multidisciplinary interest group has been created to determine priorities and coordinate efforts to improve AYA cancer services and care.
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Affiliation(s)
- Emmanuel Desandes
- CHU de Nancy, Registre national des tumeurs solides de l'enfant, Registre national des cancers de l'enfant, 54500 Vandœuvre-lès-Nancy, France; Université de Paris-Sorbonne, Inserm UMRS-1153, CRESS team 7, 75006 Paris, France.
| | - Brigitte Lacour
- CHU de Nancy, Registre national des tumeurs solides de l'enfant, Registre national des cancers de l'enfant, 54500 Vandœuvre-lès-Nancy, France; Université de Paris-Sorbonne, Inserm UMRS-1153, CRESS team 7, 75006 Paris, France
| | - Jacqueline Clavel
- Université de Paris-Sorbonne, Inserm UMRS-1153, CRESS team 7, 75006 Paris, France; Registre national des hémopathies de l'enfant, Registre national des cancers de l'enfant, 94805 Villejuif, France
| | -
- Faculté de médecine, Réseau français des registres de cancers (FRANCIM), 31000 Toulouse, France
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Ferrari A, Bisogno G, Meazza C, Vajna de Pava M, Sultan I, De Salvo GL, Clerici CA, Veneroni L, Casanova M. The challenge of access to care for soft tissue sarcomas bridging pediatric and adult age: the Italian pediatric oncology view. Expert Rev Anticancer Ther 2012; 12:243-54. [PMID: 22316372 DOI: 10.1586/era.11.209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Synovial sarcoma and rhabdomyosarcoma are two high-grade soft tissue sarcoma subtypes that occur in adolescents and young adults. Managing these malignancies in patients in this age bracket poses various clinical problems, partly because different therapeutic approaches are sometimes adopted by pediatric and adult oncologists, even though they are dealing with the same condition. In this review, the doubts concerning how best to manage soft tissue sarcomas in patients between pediatric and adult ages lead up to a more general discussion of the issue of access to optimal cancer services for adolescents and young adults - a subset of patients acknowledged as being under-represented in clinical trials on therapies that may improve their outcome. The situation in Italy is described, along with action taken in an effort to bridge the gap and implement specific programs tailored to these patients.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori Via G Venezian, Milan 1-20133, Italy.
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Desandes E, Bonnay S, Berger C, Brugieres L, Demeocq F, Laurence V, Sommelet D, Tron I, Clavel J, Lacour B. Pathways of care for adolescent patients with cancer in France from 2006 to 2007. Pediatr Blood Cancer 2012; 58:924-9. [PMID: 22180332 DOI: 10.1002/pbc.24032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 11/09/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND In France, as in other countries, there is a need for a population-based view of access to care and modalities of treatment for adolescents with cancer. PROCEDURE Using a population-based registration, we report pathways of care for 15-19-year-old patients, diagnosed with cancer in 2006 and 2007, living in six French regions, accounting for 41% of the French population. RESULTS The median times (inter-quartile range) for diagnosis and treatment of the 594 included adolescents were 8 weeks (3-17) and 3 days (0-16), respectively. First physicians met by the patients were mostly general practitioners (59%). Seventeen percent of patients were firstly seen on emergency wards. Most of the patients (82%) were treated in an adult environment. Management decisions were taken within the context of a multi-disciplinary team (MDT) in 54% of cases. Twenty-seven percent of patients were included in randomized or non-randomized clinical studies: percentage depended on the tumor type and on the number of on-going trials at the study period. Fifteen percent of patients were included in pediatric studies, 7% in adult studies, and 5% in studies including both adults and children. CONCLUSIONS The pathways of care for French adolescent patients with cancer are heterogeneous. Our results reveal differences in MDT meetings according to tumor types and a lack of effective collaboration between pediatric and adult wards. Efforts must be made to develop cancer networks to ensure that adolescents receive the optimal care in a suitable environment.
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Ferrari A, Thomas D, Franklin AR, Hayes-Lattin BM, Mascarin M, van der Graaf W, Albritton KH. Starting an Adolescent and Young Adult Program: Some Success Stories and Some Obstacles to Overcome. J Clin Oncol 2010; 28:4850-7. [DOI: 10.1200/jco.2009.23.8097] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Adolescent and young adult (AYA) patients seem to be in a sort of no-man's land, halfway between the two different worlds of pediatric and adult medical oncology and bearing the brunt, in terms of inclusion in clinical trials and quality of professional care, of the lack of integration between these two worlds. This article discusses the different organization models of care used in pediatric oncology (mainly family-focused) and in adult medical oncology (disease-focused). There is a growing awareness that these models are not ideally suited to the complex needs of AYA patients, which require a different, new, patient-focused multidisciplinary approach. A comprehensive, multipronged effort is required to bridge the gap in the care of AYA patients, with the ultimate challenge of creating a new discipline, AYA oncology. In this article, we review the experiences of AYA oncology programs in Europe, North America, and Australia, focusing on similarities and differences in strategy, as well as the major challenges and opportunities faced by these programs. Among the most important factors for the successful establishment of an AYA oncology service are the degree of engagement of both pediatric and adult medical oncologists, the philanthropic support of powerful charities, and the role of dedicated professionals across a range of disciplines in driving the development of services for AYA patients.
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Affiliation(s)
- Andrea Ferrari
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - David Thomas
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - Anna R.K. Franklin
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - Brandon M. Hayes-Lattin
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - Maurizio Mascarin
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - Winette van der Graaf
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
| | - Karen H. Albritton
- From the Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Youth Area Project, Centro di Riferimento Oncologico, Aviano, Italy; Peter MacCallum Cancer Centre, Victoria, Australia; Children's Cancer Hospital, The University of Texas M. D. Anderson Cancer Center, Houston; Cook Children's Hospital; University of North Texas Health Science Center, Fort Worth, TX; Oregon Health and Science University Knight Cancer Institute, Portland, OR; and Radboud University
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Épidémiologie des cancers chez les adolescents et les jeunes adultes, et leurs parcours de soins. PSYCHO-ONCOLOGIE 2010. [DOI: 10.1007/s11839-009-0152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pearce S. Policy and practice in teenage and young adult cancer care in England: Looking to the future. Eur J Oncol Nurs 2009; 13:149-53. [DOI: 10.1016/j.ejon.2009.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/28/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Desandes E. Survival from adolescent cancer. Cancer Treat Rev 2007; 33:609-15. [PMID: 17398011 DOI: 10.1016/j.ctrv.2006.12.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 12/19/2006] [Accepted: 12/21/2006] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adolescent cancer is the leading cause of non-accidental mortality in young people. The tumour types occurring most commonly in this age group are distinctive and differ markedly from those developing in younger children and older adults. OBJECTIVE The aim is to present survival data for the major types of cancer and for all malignancies combined in adolescents aged from 15 to 19 years, highlighting intercountry differences, temporal trends, and age/treatment regimen comparisons of survival rates. RESULTS Results from European and American data show that 5-year overall survival among adolescents with cancer is approximately 73-78%, close to that observed among children. As in paediatric series, there are geographical differences, with lower survival rates in Eastern European countries. Adolescents have substantially lower survival than children for acute lymphoid leukaemia, malignant non-Hodgkin lymphoma, Ewing's tumour, osteosarcoma, soft-tissue sarcoma. Temporal improvement in survival from children cancer is twice higher than survival from adolescents malignancies. CONCLUSION Several reasons could explain these geographical differences, such as better referral, greater availability of complex and expensive treatment regimens, reflecting variations in health care systems and resources. Age-group variations could be explained by differences in biology and in treatment regimen, and lack of participation in clinical trials. Some are inherent in the psychosocial characteristics of these patients, such as delays in seeking medical attention, poor compliance with treatment. It is necessary to focus on cancer in adolescence, as the new frontier in oncology, and adolescents with cancer must be now the subject of specific survival analyses.
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Affiliation(s)
- Emmanuel Desandes
- French National Registry of Childhood Solid Tumours, Université Henri Poincaré Nancy 1, Faculté de Médecine, 9, Avenue de la Forêt de Haye, BP 184, 54505 Vandoeuvre-lès-Nancy cedex, France.
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