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van der Meer DJ, van der Graaf WTA, van de Wal D, Karim-Kos HE, Husson O. Long-term second primary cancer risk in adolescent and young adult (15-39 years) cancer survivors: a population-based study in the Netherlands between 1989 and 2018. ESMO Open 2024; 9:102203. [PMID: 38171190 PMCID: PMC10837779 DOI: 10.1016/j.esmoop.2023.102203] [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] [Received: 09/24/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Few studies have comprehensively investigated the long-term second cancer risk among adolescent and young adult (AYA, aged 15-39 years) cancer survivors. This study investigated the long-term second cancer risk by including the full range of first and second cancer combinations with at least 10 observations in the Netherlands between 1989 and 2018. MATERIALS AND METHODS First and second primary cancer data of all 6-month AYA cancer survivors were obtained from the nationwide population-based Netherlands Cancer Registry. Excess cancer risk compared to the general population was assessed with standardized incidence ratio (SIR) and absolute excess risk (AER) statistics up to 25 years after diagnosis. Cumulative incidences were estimated, using death as a competing risk factor. Analyses were carried out with and without applying multiple cancer rules. RESULTS The cohort included 99 502 AYA cancer survivors. Male survivors had a 2-fold higher risk of developing any cancer compared to the general population, whereas this was around 1.3-fold in females. AERs were 17.5 and 10.1 per 10 000 person-years for males and females. The long-term excess risk of cancer was significantly higher for most first and second primary cancer combinations, but comparable and lower risk estimates were also observed. Application of the multiple cancer rules resulted in a noticeable risk underestimation in melanoma, testicular, and breast cancer survivors. Risk outcomes remained similar in most cases otherwise. The cumulative incidence of second cancer overall increased over time up to 8.9% in males and 10.3% in females at 25 years' follow-up. Highest long-term cumulative incidences were observed among lymphoma survivors (13.3% males and 18.9% females). CONCLUSIONS AYA cancer survivors have a higher cancer risk compared to the general population for most cancers up to 25 years after their initial cancer diagnosis. Additional studies that investigate risk factors for the specific cancer type combinations are needed to develop personalized follow-up strategies.
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Affiliation(s)
- D J van der Meer
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam
| | - D van de Wal
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - H E Karim-Kos
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kazzi AI, Diniz PH, Mano M, Nogueira-Rodrigues A. Challenging Outlook of Caring for Adolescents and Young Adults With Cancer in Brazil: Results of a Nationwide Survey. JCO Glob Oncol 2023; 9:e2300078. [PMID: 37561979 PMCID: PMC10581624 DOI: 10.1200/go.23.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The global burden of cancer in adolescents and young adults (AYAs) emerges as a major public health issue, in which remarkable challenges and unmet needs are evident. Because of sociodemographic inequalities, initiatives to change this scenario need to be expanded globally, particularly to low-middle-income countries (LMICs). This study aimed to gain information about the standards of AYA cancer care in Brazil from the physician's perspective. METHODS Physicians involved in AYA cancer care were invited to answer a national online survey. The questions covered several aspects from health care's demographics to specialized services availability, such as fertility and genetic counseling. The availability of a specialized AYA cancer care facility was the primary study end point, and the findings were stratified by region and treatment setting (public v private). RESULTS Among the physicians who responded (N = 249), 90% reported no access to a specialized AYA service. Only 20% had access to a fertility specialist, and 30% to a survivorship program in their institutions. Even external referrals to medical specialties were challenging, with 24% of the physicians reporting challenges. Despite the potential cardiotoxicity related to treatments, 43% of the respondents reported to refer patients for cardio-oncologists hardly ever. Furthermore, 36% of physicians had never enrolled AYA patients into clinical trials and 42% had never ordered a genetic test. Lack of specialized human resources was particularly evident in Northern Brazil, and delays in cancer diagnoses were frequent. CONCLUSION This first study addresses standards of AYA cancer care across Brazil. Importantly, the data disclose significant infrastructural gaps, implying that major investments in training and infrastructure are urgently needed. These data may mirror other LMICs reality.
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Affiliation(s)
- Ana I.M. Kazzi
- Grupo Oncoclínicas, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Max Mano
- Grupo Oncoclínicas, Belo Horizonte, Brazil
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Forster AS, Herbert A, Koo MM, Taylor RM, Gibson F, Whelan JS, Lyratzopoulos G, Fern LA. Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort. Br J Cancer 2022; 126:1725-1734. [PMID: 35190694 PMCID: PMC9174449 DOI: 10.1038/s41416-022-01698-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The association of diagnostic intervals and outcomes is poorly understood in adolescents and young adults with cancer (AYA). We investigated associations between diagnostic intervals and health-related quality of life (HRQoL), anxiety and depression in a large AYA cohort. METHODS Participants aged 12-24 completed interviews post-diagnosis, providing data on diagnostic experiences and the patient-reported outcomes (PROs) HRQoL, anxiety and depression. Demographic and cancer information were obtained from clinical and national records. Six diagnostic intervals were considered. Relationships between intervals and PROs were examined using regression models. RESULTS Eight hundred and thirty participants completed interviews. In adjusted models, across 28 of 30 associations, longer intervals were associated with poorer PROs. Patient intervals (symptom onset to first seeing a GP) of ≥1 month were associated with greater depression (adjusted odds ratio (aOR):1.7, 95% Confidence Interval (CI):1.1-2.5) compared to <1 month. ≥3 pre-referral GP consultations were associated with greater anxiety (aOR:1.6, CI:1.1-2.3) compared to 1-2 consultations. Symptom onset to first oncology appointment intervals of ≥2 months was associated with impaired HRQoL (aOR:1.8, CI:1.2-2.5) compared to <2 months. CONCLUSIONS Prolonged diagnostic intervals in AYA are associated with an increased risk of impaired HRQoL, anxiety and depression. Identifying and delivering interventions for this high-risk group is a priority.
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Affiliation(s)
- Alice S Forster
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Annie Herbert
- Medical Research Council, Integrative Epidemiology Unit at University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- Population Health Sciences, University of Bristol, Bristol, BS8 2BN, UK
| | - Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7YH, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Jeremy S Whelan
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Group, Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK.
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Yield of flow cytometry in addition to cytology for lymph node sampling in patients with incidental axillary adenopathy without a concurrent diagnosis of primary breast malignancy. Breast Cancer Res Treat 2022; 191:677-683. [PMID: 35013915 PMCID: PMC8747879 DOI: 10.1007/s10549-021-06473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/02/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Non-specific lymphadenopathy is increasingly being reported especially given the COVID-19 vaccination campaign and is a diagnostic dilemma especially in oncology patients. The purpose of this study was to evaluate the diagnostic accuracy and discordance rate between fine-needle aspiration (FNA) cytology and flow cytometry (FC) immunophenotyping in axillary FNA in patients with morphologically abnormal axillary lymph nodes on imaging and no concurrent diagnosis of primary breast malignancy. METHODS This retrospective study included 222 patients who underwent screening or diagnostic axillary ultrasound that yielded suspicious lymphadenopathy without concurrent or recent prior diagnosis of breast cancer and who had subsequent image-guided axillary FNA and FC. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive value (PPV and NPV) were reported for FNA with cytology alone, and FC alone, and in combination. Discordance rate between FNA cytology and FC was assessed. Discordant cases were evaluated with histology or clinical and imaging follow-up. RESULTS Diagnostic sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 88%, 92%, 77%, 96%, and 91%, for FNA alone, 98%, 98%, 92%, 99%, and 98% for FC alone, and 100%, 92%, 79%, 100%, and 94% when combined. The overall discordance rate between FNA and FC was 7% (16/222). 7/16 (44%) patients with discordant results were diagnosed with lymphoma, while 9/16 (56%) patients with discordant results had benign findings. CONCLUSION With a diagnostic accuracy of 91%, FNA with cytology is sufficient to screen patients with indeterminate and incidental lymphadenopathy. Flow cytometry could be initially deferred in patients with low pretest probability of lymphoma.
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Guleria B, Viswanath S, Soneji D, Kapoor R, Guleria P, Suresh P, Kumar M, Patel A, Swamy S. Cancer in the Adolescent and Young Adults (AYA) and Children: A Comprehensive Analysis of the Epidemiology and Psychosocial Morbidity in the Indian Population. South Asian J Cancer 2021; 11:73-81. [PMID: 35833048 PMCID: PMC9273329 DOI: 10.1055/s-0041-1735482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims
Adolescent and young adults (AYAs), children with cancer, and their guardians have unique psychosocial morbidities adversely effecting quality of life (QOL). This is measurable using patented tools. We analyzed epidemiological and clinicopathological patterns of solid organ cancers in this subgroup. We also assessed psychosocial morbidity and changes in QOL faced by them.
Methods
All patients aged 2 to 39 years, newly diagnosed with cancer from April 2017 to March 2019 were included. Clinical history, diagnosis, staging, treatment, outcomes, and follow-up were recorded. The National Comprehensive Cancer Network (NCCN) distress thermometer and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C-30) were used to assess psychosocial morbidity of AYAs, children ≥ 12 years, and parents of children < 12 years. Pediatric Quality of Life Inventory (Peds QL) version 3.0 was used for children < 12 years. Data was analyzed using descriptive statistics.
Results
A total of 571 patients (512 AYAs, 59 children) were enrolled. Median age was 30 years with male predominance (58.1%). Most cases (98.6%) were absent from school or work. Carcinoma breast was the most common in females (29.3%) and non-Hodgkin lymphoma in males (12.6%). 91.06% had overall NCCN distress score ≥ 4. Also, 73.81 and 79.49% had “quite a bit” or “very much” responses on functional and symptom scales, respectively, in EORTC QLQ C-30 questionnaire. Peds QL version 3.0 revealed total score ranging from 276 to 523 for each patient.
Conclusion
AYAs and children with cancer are extremely vulnerable to psychological stress and morbidity. Use of well-established tools help in assessing their mental status and timely psychiatric referral can be initiated.
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Affiliation(s)
- Bhupesh Guleria
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - S. Viswanath
- Department of Medical Oncology, Malignant Diseases Treatment Center, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Dharmesh Soneji
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Rajan Kapoor
- Department of Hematology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
| | - Prerna Guleria
- Department of Pathology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - P. Suresh
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Manish Kumar
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
| | - Amol Patel
- Department of Medical Oncology, INHS ASVINI, Mumbai, Maharashtra, India
| | - Shivshankar Swamy
- Department of Medical Oncology, Malignant Diseases Treatment Center, Army Hospital Research and Referral, New Delhi, India
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You L, Lv Z, Li C, Ye W, Zhou Y, Jin J, Han Q. Worldwide cancer statistics of adolescents and young adults in 2019: a systematic analysis of the Global Burden of Disease Study 2019. ESMO Open 2021; 6:100255. [PMID: 34481330 PMCID: PMC8417345 DOI: 10.1016/j.esmoop.2021.100255] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/18/2021] [Accepted: 08/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background The cancer burden in adolescents and young adults (AYAs) deserves more attention. However, global cancer statistics for AYAs are often presented as aggregates, concealing important heterogeneity. This study aimed to describe the worldwide profile of cancer incidence, mortality, and corresponding trends from 1990 to 2019 among 15-39-year olds by focusing on the patterns by age, sex, sociodemographic index (SDI), and regions. Patients and methods Global, regional, and country data on the number of cancer cases and cancer-related deaths for 29 cancer types were collected from the 2019 Global Burden of Disease (GBD) Study. We also summarized the results using five levels of the SDI and 21 GBD regions. Results In 2019, an estimated 1 335 100 new cancer cases and 397 583 cancer-related deaths occurred among AYAs worldwide. While the incidence rate increased mildly, the death rate decreased significantly between 1990 and 2019, with an estimated annual percentage change of 0.38 (95% confidence interval 0.36-0.39) and −0.93 (95% confidence interval −0.95 to −0.92), respectively. The cancer burden was disproportionally greater among women than among men. The cancer profiles varied substantially across geographical regions, with the highest burden being in South Asia and East Asia. Besides, the cancer incidence in the high SDI regions was four times higher than that in the low SDI regions; however, the mortality burden in the high SDI region was lower than that in the low SDI region, which reflected the differences in cancer profiles across SDI regions and the inferior outcomes in the low SDI regions. Conclusion This study updates the previous epidemiological data of the cancer burden of AYAs. The cancer burden in AYAs varied substantially according to age, sex, SDI, and geographical regions. These findings highlight that the specific cancer profile of AYA patients requires targeted cancer control measures to reduce the cancer burden in this age group. The cancer burden in AYAs varied substantially according to age, sex, SDI, and geographical regions. Cancer burden in AYAs was disproportionally greater among women than among men. Cancer profiles of AYAs varied across different geographical regions and SDI regions. Cancer burden in AYAs was still considerable in the low SDI regions.
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Affiliation(s)
- L You
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, Zhejiang, People's Republic of China
| | - Z Lv
- Xinyuan Institute of Medicine and Biotechnology, School of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, People's Republic of China
| | - C Li
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, Zhejiang, People's Republic of China
| | - W Ye
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, Zhejiang, People's Republic of China
| | - Y Zhou
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, Zhejiang, People's Republic of China
| | - J Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Zhejiang Province Key Laboratory of Hematology Oncology Diagnosis and Treatment, Hangzhou, Zhejiang, People's Republic of China.
| | - Q Han
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China; Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
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International trends in the incidence of brain tumours in children and young-adults and their association with indicators of economic development. Cancer Epidemiol 2021; 74:102006. [PMID: 34418666 DOI: 10.1016/j.canep.2021.102006] [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] [Received: 03/16/2021] [Revised: 06/21/2021] [Accepted: 08/07/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Childhood brain tumours (CBTs) are the second most common type of cancer in individuals aged 0-24 years globally and cause significant morbidity and mortality. CBT aetiology remains poorly understood, however previous studies found higher CBT incidence in high-income countries (HIC) compared to low-middle income countries (LMIC), suggesting a positive relationship between incidence and wealth. MATERIALS & METHODS Aggregated data from Cancer Incidence in Five Continents (CI5) were used to explore CBT epidemiology. Incidence rate ratios (IRR) compared CBT rates between twenty-five geographically and economically diverse countries. The relationship between incidence and economic development was explored using linear regression models and Spearman's rank correlation tests. Trends in CBT incidence between 1978 and 2012 were investigated using average annual percentage changes (AAPC). RESULTS CBT incidence was highest in North America and lowest in Africa. CBT incidence rates increased significantly with increasing GDP per capita (p = 0.006). Gini index was significantly negatively associated with CBT incidence. Incidence decreased with increasing income inequality within countries, indicated by higher Gini indices (p = 0.040). Increasing and decreasing CBT incidence trends were observed within individual countries, although only Italy (p = 0.02) and New Zealand (p < 0.005) experienced statistically significant changes over time. CONCLUSIONS The excess disease found in HIC may be explained by environmental risk factor exposure increasing CBT risk in wealthy populations. However, systematic limitations of substandard cancer detection and reporting in LMIC may mean incidence disparities result from misinformation bias rather than genuine differences in risk factor exposure. Further research is required to comprehensively describe CBT epidemiology and explain study findings.
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Albasri AM, Ansari IA. Pattern of cancers in adolescent and young adults.: A 15-year retrospective study at King Fahad Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia. Saudi Med J 2021; 42:449-453. [PMID: 33795503 PMCID: PMC8128634 DOI: 10.15537/smj.2021.42.4.20210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the incidence and pattern of cancer in adolescents and young adults (AYAs) age group in Al-Madinah Al-Munawwarah region of Saudi Arabia. METHODS This retrospective histopathology-based study was conducted at a tertiary care center in Al-Madinah Al-Munawwarah, Saudi Arabia and comprised cases of cancers for 15 years between January 2006 and December 2020. RESULTS During the last 15-year period, 8,769 cases of cancers were diagnosed out of which 475 (5.4%) cases were registered in AYAs. Of these cases, 232 (48.8%) were males while 243 (51.2%) were females, with a male-to-female ratio of 0.9:1. The 3 most common cancer groups in the entire cohort were carcinomas (n=165; 34.7%), lymphomas (n=135; 28.4%), and leukemias (n=91; 19.2%). The most common sites in carcinomas were thyroid (n=60; 12.6%), breast (n=35; 7.4%), and gastrointestinal (n=18; 3.8%). The leading cancers in males were the lymphomas (n=74; 15.6%), leukemias (n=57; 12%), bone (n=21; 4.4%), and central nervous system (n=20; 4.2%), while in females, the most common cancers were the lymphomas (n=61; 12.8%), thyroid (n=40; 8.4%), breast (n=34; 7.2%), and leukemias (n=34; 7.2%). CONCLUSION Our findings are in concordance with studies in national and international literature and we believe that our study provides a baseline tool for future population-targeted studies.
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Affiliation(s)
- Abdulkader M. Albasri
- From the Department of Pathology, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia.
- Address correspondence and reprints request to: Dr. Abdulkader M. Albasri, Associate Professor, Department of Pathology, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-1824-4025
| | - Irfan A. Ansari
- From the Department of Pathology, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia.
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Gibson F, Fern LA, Phillips B, Gravestock H, Malik S, Callaghan A, Dyker K, Groszmann M, Hamrang L, Hough R, McGeachy D, Morgan S, Smith S, Upadhyaya S, Veitch H, Williamson M, Whelan J, Aldiss S. Reporting the whole story: Analysis of the 'out-of-scope' questions from the James Lind Alliance Teenage and Young Adult Cancer Priority Setting Partnership Survey. Health Expect 2021; 24:1593-1606. [PMID: 34247435 PMCID: PMC8483195 DOI: 10.1111/hex.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective We conducted a UK‐wide survey to identify the top 10 research questions for young people's cancer. We conducted secondary analysis of questions submitted, which were ‘out‐of‐scope’ of the original survey aim. We sought to disseminate these questions, to inform practice, policy and the development of potential interventions to support young people with cancer. Design James Lind Alliance Priority Setting Partnership. Participants Young people aged 13‐24 with a current/previous cancer diagnosis, their families/friends/partners and professionals who work with this population. Methods Eight hundred and fifty‐five potential research questions were submitted, and 326 were classified as ‘out‐of‐scope’. These questions, along with 49 ‘free‐text’ comments, were analysed using thematic analysis. Results The 375 out‐of‐scope questions and comments were submitted by: 68 young people, 81 family members/partners/friends and 42 professionals. Ten overarching themes were identified: diagnostic experience; communication; coordination of care; information needs and lack of information; service provision; long‐term effects and aftercare support; family support; financial impact; end‐of life care; and research methods and current research. Conclusions The need to tailor services, information and communication is a striking thread evidenced across the ‘out‐of‐scope’ questions. Gaps in information highlight implications for practice in revisiting information needs throughout the cancer trajectory. We must advocate for specialist care for young people and promote the research priorities and these findings to funding bodies, charities, young people and health and social care policymakers, in order to generate an evidence base to inform effective interventions across the cancer trajectory and improve outcomes. Patient/public contributions Patients and carers were equal stakeholders throughout.
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Affiliation(s)
- Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna A Fern
- Cancer Clinical Trials Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK.,Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
| | - Helen Gravestock
- Policy, Influencing and Voice, Young Lives vs Cancer, London, UK
| | - Sonia Malik
- Policy and Influencing, Young Lives vs Cancer, London, UK
| | - Amy Callaghan
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Karen Dyker
- Clinical Oncology Department, Clinical Oncology Department, St James's University Hospital, Leeds, UK
| | - Mike Groszmann
- Psychological Medicine Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leila Hamrang
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Manchester, UK
| | - Rachael Hough
- Department of Adolescent Haematology, Children and Young People's Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Demi McGeachy
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, Glasgow, UK
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Ward L33, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sheela Upadhyaya
- Trials and Studies Coordinating Centre, The James Lind Alliance, National Institute for Health Research Evaluation, University of Southampton, Southampton, UK
| | | | - Max Williamson
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Jeremy Whelan
- Division of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
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Leung AWK, Loong HHF, Tse T, Li CK. Management of Malignancies Developing in AYA. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2021. [DOI: 10.15264/cpho.2021.28.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alex WK. Leung
- Department of Pediatrics The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Herbert HF. Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Teresa Tse
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Chi-kong Li
- Department of Pediatrics The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Department of Pediatrics and Adolescent Medicine, Hong Kong Children Hospital, Hong Kong SAR, China
- Hong Kong Hub of Pediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
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Fern LA, Taylor RM, Barber J, Alvarez-Galvez J, Feltbower R, Lea S, Martins A, Morris S, Hooker L, Gibson F, Raine R, Stark DP, Whelan J. Processes of care and survival associated with treatment in specialist teenage and young adult cancer centres: results from the BRIGHTLIGHT cohort study. BMJ Open 2021; 11:e044854. [PMID: 33827838 PMCID: PMC8031022 DOI: 10.1136/bmjopen-2020-044854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Survival gains in teenagers and young adults (TYA) are reported to be lower than children and adults for some cancers. Place of care is implicated, influencing access to specialist TYA professionals and research.Consequently, age-appropriate specialist cancer care is advocated for TYA although systematic investigation of associated outcomes is lacking. In England, age-appropriate care is delivered through 13 Principal Treatment Centres (TYA-PTC). BRIGHTLIGHT is the national evaluation of TYA cancer services to examine outcomes associated with differing places and levels of care. We aimed to examine the association between exposure to TYA-PTC care, survival and documentation of clinical processes of care. DESIGN Prospective cohort study. SETTING 109 National Health Service (NHS) hospitals across England. PARTICIPANTS 1114 TYA, aged 13-24, newly diagnosed with cancer between 2012 and 2014. INTERVENTION Participants were assigned a TYA-PTC category dependent on the proportion of care delivered in a TYA-PTC in the first year after diagnosis: all care in a TYA-PTC (ALL-TYA-PTC, n=270), no care in a TYA-PTC (NO-TYA-PTC, n=359), and some care in a TYA-PTC with additional care in a children's/adult unit (SOME-TYA-PTC, n=419). PRIMARY OUTCOME Data were collected on documented processes indicative of age-appropriate care using clinical report forms, and survival through linkage to NHS databases. RESULTS TYA receiving NO-TYA-PTC care were less likely to have documentation of molecular diagnosis, be reviewed by a children's or TYA multidisciplinary team, be assessed by supportive care services or have a fertility discussion. There was no significant difference in survival according to category of care. There was weak evidence that the association between care category and survival differed by age (p=0.08) with higher HRs for those over 19 receiving ALL or SOME-TYA-PTC compared with NO-TYA-PTC. CONCLUSION TYA-PTC care was associated with better documentation of clinical processes associated with age-appropriate care but not improved survival.
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Affiliation(s)
- Lorna A Fern
- Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and AHP Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
| | | | - Sarah Lea
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ana Martins
- Cancer Clinical Trials, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Morris
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Louise Hooker
- Wessex Teenage and Young Adult Cancer Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Institute of Epidemiology & Health, University College London, London, UK
| | - Dan P Stark
- Leeds Insitute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Jeremy Whelan
- Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
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12
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Sánchez Martínez DA, Cañadilla-Ferreira M, Henarejos PS, Alonso Romero JL. Analysis of adolescent oncology cases from 2008 through 2018 in a tertiary-level hospital: an opportunity for improvement. Future Oncol 2021; 17:1545-1551. [PMID: 33626935 DOI: 10.2217/fon-2020-0475] [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: 11/21/2022] Open
Abstract
Purpose: The purpose of this study was to disclose the variability of pathways currently taken in the treatment of adolescent patients from diagnosis to final follow-up with a view to developing a more homogenous system. Patients & methods: A cross-sectional, observational and retrospective study of the cancer diagnosis and assignment to medical care teams in adolescent patients (12-20 years) from January 2008 to December 2018 was conducted. A total of 345 adolescent patients aged between 12 and 20 years, diagnosed with cancer and treated at Hospital Clinico Universitario Virgen de la Arrixaca were included. Results: CNS tumors, followed by leukemia were the most frequent tumors. At the time of diagnosis, the highest incidences of patients were assisted in the pediatrics service adult oncology service (21.7%) and hematology (11%). Conclusion: Our aim is to highlight the need for a better transition for patients from pediatric to adult oncology and hematology services.
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Affiliation(s)
- Domingo A Sánchez Martínez
- IMIB Arrixaca, Medical Oncology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, 30120, Spain
| | - Marta Cañadilla-Ferreira
- IMIB Arrixaca, Preventive Medicine & Health Public Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, 30120, Spain
| | - Pilar Sánchez Henarejos
- IMIB Arrixaca, Medical Oncology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, 30120, Spain
| | - José Luis Alonso Romero
- IMIB Arrixaca, Medical Oncology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, 30120, Spain
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13
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Girardi F, Allemani C, Coleman MP. Global Trends in Survival From Astrocytic Tumors in Adolescents and Young Adults: A Systematic Review. JNCI Cancer Spectr 2020; 4:pkaa049. [PMID: 33134829 PMCID: PMC7583144 DOI: 10.1093/jncics/pkaa049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Brain tumors represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first, to our knowledge, systematic review of time trends and geographical variation in survival in this age group. Methods We included observational studies describing population-based survival from astrocytic tumors in patients aged 15-39 years. We queried 6 electronic databases from database inception to December 31, 2019. This review is registered with PROSPERO, number CRD42018111981. Results Among 5640 retrieved records, 20 studies fulfilled the inclusion criteria. All but 1 study focused on high-income countries. Five-year survival from astrocytoma (broad morphology group) mostly varied between 48.0% and 71.0% (1973-2004) without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when nonmalignant tumors were excluded. During 2002-2007, 5-year survival for World Health Organization grade I-II tumors was in the range of 72.6%-89.1% in England, Germany, and the United States but lower in Southeastern Europe (59.0%). Five-year survival for anaplastic astrocytoma varied between 39.6% and 55.4% (2002-2007). Five-year survival from glioblastoma was in the range of 14.2%-23.1% (1991-2009). Conclusions Survival from astrocytic tumors remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including underrepresented populations and providing more recent survival estimates.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
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14
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Barr RD, Ries LAG, Trama A, Gatta G, Steliarova-Foucher E, Stiller CA, Bleyer WA. A system for classifying cancers diagnosed in adolescents and young adults. Cancer 2020; 126:4634-4659. [PMID: 32901932 DOI: 10.1002/cncr.33041] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/28/2022]
Abstract
Cancer types in adolescents and young adults form a unique distribution. A system for classifying them is presented.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Annalisa Trama
- IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Gemma Gatta
- IRCCS Foundation, National Cancer Institute, Milan, Italy
| | | | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, Oxford, United Kingdom
| | - W Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
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15
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Shaikh F, Stark D, Fonseca A, Dang H, Xia C, Krailo M, Pashankar F, Rodriguez-Galindo C, Olson TA, Nicholson JC, Murray MJ, Amatruda JF, Billmire D, Stoneham S, Frazier AL. Outcomes of adolescent males with extracranial metastatic germ cell tumors: A report from the Malignant Germ Cell Tumor International Consortium. Cancer 2020; 127:193-202. [PMID: 33079404 DOI: 10.1002/cncr.33273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescents with extracranial metastatic germ cell tumors (GCTs) are often treated with regimens developed for children, but their clinical characteristics more closely resemble those of young adult patients. This study was designed to determine event-free survival (EFS) for adolescents with GCTs and compared them with children and young adults. METHODS An individual patient database of 11 GCT trials was assembled: 8 conducted by pediatric cooperative groups and 3 conducted by an adult group. Male patients aged 0 to 30 years with metastatic, nonseminomatous, malignant GCTs of the testis, retroperitoneum, or mediastinum who were treated with platinum-based chemotherapy were included. The age groups were categorized as children (0 to <11 years), adolescents (11 to <18 years), and young adults (18 to ≤30 years). The study compared EFS and adjusted for risk group by using Cox proportional hazards analysis. RESULTS From a total of 2024 individual records, 593 patients met the inclusion criteria: 90 were children, 109 were adolescents, and 394 were young adults. The 5-year EFS rate was lower for adolescents (72%; 95% confidence interval [CI], 62%-79%) than children (90%; 95% CI, 81%-95%; P = .003) or young adults (88%; 95% CI, 84%-91%; P = .0002). The International Germ Cell Cancer Collaborative Group risk group was associated with EFS in the adolescent age group (P = .0020). After adjustments for risk group, the difference in EFS between adolescents and children remained significant (hazard ratio, 0.30; P = .001). CONCLUSIONS EFS for adolescent patients with metastatic GCTs was similar to that for young adults but significantly worse than for that children. This finding highlights the importance of coordinating initiatives across clinical trial organizations to improve outcomes for adolescents and young adults. LAY SUMMARY Adolescent males with metastatic germ cell tumors (GCTs) are frequently treated with regimens developed for children. In this study, a large data set of male patients with metastatic GCTs across different age groups has been built to understand the outcomes of adolescent patients in comparison with children and young adults. The results suggest that adolescent males with metastatic GCTs have worse results than children and are more similar to young adults with GCTs. Therefore, the treatment of adolescents with GCTs should resemble therapeutic approaches for young adults.
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Affiliation(s)
- Furqan Shaikh
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Stark
- Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Adriana Fonseca
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ha Dang
- Children's Oncology Group, Monrovia, California
| | - Caihong Xia
- Children's Oncology Group, Monrovia, California
| | - Mark Krailo
- Children's Oncology Group, Monrovia, California
| | | | | | - Thomas A Olson
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - James C Nicholson
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Matthew J Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - James F Amatruda
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | | | - Sara Stoneham
- Children's and Young Persons Cancer Services, University College London Hospital Trusts, London, United Kingdom
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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16
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Koo MM, Lyratzopoulos G, Herbert A, Abel GA, Taylor RM, Barber JA, Gibson F, Whelan J, Fern LA. Association of Self-reported Presenting Symptoms With Timeliness of Help-Seeking Among Adolescents and Young Adults With Cancer in the BRIGHTLIGHT Study. JAMA Netw Open 2020; 3:e2015437. [PMID: 32880648 PMCID: PMC7489839 DOI: 10.1001/jamanetworkopen.2020.15437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/20/2020] [Indexed: 01/01/2023] Open
Abstract
Importance Evidence regarding the presenting symptoms of cancer in adolescents and young adults can support the development of early diagnosis interventions. Objective To examine common presenting symptoms in adolescents and young adults aged 12 to 24 years who subsequently received a diagnosis of cancer and potential variation in time to help-seeking by presenting symptom. Design, Setting, and Participants This multicenter study is a cross-sectional analysis of the BRIGHTLIGHT cohort study, which was conducted across hospitals in England. Participants included adolescents and young adults aged 12 to 24 years with cancer. Information on 17 prespecified presenting symptoms and the interval between symptom onset and help-seeking (the patient interval) was collected through structured face-to-face interviews and was linked to national cancer registry data. Data analysis was performed from January 2018 to August 2019. Exposures Self-reported presenting symptoms. Main Outcomes and Measures The main outcomes were frequencies of presenting symptoms and associated symptom signatures by cancer group and the proportion of patients with each presenting symptom whose patient interval was longer than 1 month. Results The study population consisted of 803 adolescents and young adults with valid symptom information (443 male [55%]; 509 [63%] aged 19-24 years; 705 [88%] White). The number of symptoms varied by cancer group: for example, 88 patients with leukemia (86%) presented with 2 or more symptoms, whereas only 9 patients with melanoma (31%) presented with multiple symptoms. In total, 352 unique symptom combinations were reported, with the 10 most frequent combinations accounting for 304 patients (38%). Lump or swelling was reported by more than one-half the patients (419 patients [52%; 95% CI, 49%-56%]). Other common presenting symptoms across all cancers were extreme tiredness (308 patients [38%; 95% CI, 35%-42%]), unexplained pain (281 patients [35%; 95% CI, 32%-38%]), night sweats (192 patients [24%; 95% CI, 21%-27%]), lymphadenopathy (191 patients [24%; 95% CI, 21%-27%]), and weight loss (190 patients [24%; 95% CI, 21%-27%]). The relative frequencies of presenting symptoms also varied by cancer group; some symptoms (such as lump or swelling) were highly prevalent across several cancer groups (seen in >50% of patients with lymphomas, germ cell cancers, carcinomas, bone tumors, and soft-tissue sarcomas). More than 1 in 4 patients (27%) reported a patient interval longer than 1 month; this varied from 6% (1 patient) for fits and seizures to 43% (18 patients) for recurrent infections. Conclusions and Relevance Adolescents and young adults with cancer present with a broad spectrum of symptoms, some of which are shared across cancer types. These findings point to discordant presenting symptom prevalence estimates when information is obtained from patient report vs health records and indicate the need for further symptom epidemiology research in this population.
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Affiliation(s)
- Minjoung M. Koo
- Epidemiology of Cancer and Healthcare Outcomes Research Group, Department of Behavioural Sciences and Health, University College London, London, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer and Healthcare Outcomes Research Group, Department of Behavioural Sciences and Health, University College London, London, United Kingdom
| | - Annie Herbert
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Gary A. Abel
- University of Exeter Medical School, St Luke’s Campus, Exeter, United Kingdom
| | - Rachel M. Taylor
- Centre for Nurse, Midwife, and Allied Health Professional-led Research, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Julie A. Barber
- Department of Statistical Science, University College London, London, United Kingdom
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Jeremy Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lorna A. Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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17
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Henson KE, Elliss-Brookes L, Coupland VH, Payne E, Vernon S, Rous B, Rashbass J. Data Resource Profile: National Cancer Registration Dataset in England. Int J Epidemiol 2020; 49:16-16h. [PMID: 31120104 PMCID: PMC7124503 DOI: 10.1093/ije/dyz076] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katherine E Henson
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Lucy Elliss-Brookes
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Victoria H Coupland
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Elsita Payne
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Sally Vernon
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Brian Rous
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Jem Rashbass
- National Disease Registration, National Cancer Registration and Analysis Service, Public Health England, London, UK
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18
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Cumulative burden of subsequent neoplasms, cardiovascular and respiratory morbidity in young people surviving cancer. Cancer Epidemiol 2020; 66:101711. [PMID: 32279022 DOI: 10.1016/j.canep.2020.101711] [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: 11/21/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Long-term childhood and young adult cancer survivors are at increased risk of the late effects of multiple chronic conditions. In this study we estimate the cumulative burden of subsequent malignant neoplasms (SMN), cardiovascular and respiratory hospitalisations in long-term survivors of childhood and young adult cancers and associated treatment risks. METHODS Five-year survivors of cancer diagnosed aged 0-29 years between 1992-2009 in Yorkshire, UK were included. The cumulative count of all hospital admissions (including readmissions) for cardiovascular and respiratory conditions and all SMNs diagnosed up to 2015 was calculated, with death as a competing risk. Associations between treatment exposures and cumulative burden were investigated using multiple-failure time survival models. RESULTS A total of 3464 5-year survivors were included with a median follow-up of 8.2 years (IQR 4-13 years). Ten-years post diagnosis, the cumulative incidence for a respiratory admission was 6.0 % (95 %CI 5.2-6.9), a cardiovascular admission was 2.0 % (95 %CI 1.5-2.5), and SMN was 1.0 % (95 % CI 0.7-1.4) with an average of 13 events per 100 survivors observed (95 %CI 11-15). The risk of experiencing multiple events was higher for those treated with chemotherapy drugs with known lung toxicity (HR = 1.35, 95 %CI 1.09-1.68). DISCUSSION Survivors of childhood and young adult cancer experience a high burden of morbidity due to respiratory, cardiovascular diseases and SMNs up to 20-years post-diagnosis. Statistical methods that capture multiple morbidities and recurrent events are important when quantifying the burden of late effects in young cancer survivors.
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19
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Ciftci HI, Bayrak N, Yıldırım H, Yıldız M, Radwan MO, Otsuka M, Fujita M, Tuyun AF. Discovery and structure–activity relationship of plastoquinone analogs as anticancer agents against chronic myelogenous leukemia cells. Arch Pharm (Weinheim) 2019; 352:e1900170. [DOI: 10.1002/ardp.201900170] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/03/2019] [Accepted: 09/07/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Halil I. Ciftci
- Department of Drug DiscoveryScience Farm Ltd Kumamoto Japan
- Medicinal and Biological Chemistry Science Farm Joint Research Laboratory, Faculty of Life SciencesKumamoto University Kumamoto Japan
| | - Nilüfer Bayrak
- Department of Chemistry, Faculty of EngineeringIstanbul University‐Cerrahpasa Istanbul Turkey
| | - Hatice Yıldırım
- Department of Chemistry, Faculty of EngineeringIstanbul University‐Cerrahpasa Istanbul Turkey
| | - Mahmut Yıldız
- Department of ChemistryGebze Technical University Kocaeli Turkey
| | - Mohamed O. Radwan
- Department of Drug DiscoveryScience Farm Ltd Kumamoto Japan
- Medicinal and Biological Chemistry Science Farm Joint Research Laboratory, Faculty of Life SciencesKumamoto University Kumamoto Japan
- Department of Chemistry of Natural Compounds, Pharmaceutical and Drug Industries Research DivisionNational Research Centre Cairo Egypt
| | - Masami Otsuka
- Department of Drug DiscoveryScience Farm Ltd Kumamoto Japan
- Medicinal and Biological Chemistry Science Farm Joint Research Laboratory, Faculty of Life SciencesKumamoto University Kumamoto Japan
| | - Mikako Fujita
- Medicinal and Biological Chemistry Science Farm Joint Research Laboratory, Faculty of Life SciencesKumamoto University Kumamoto Japan
| | - Amaç F. Tuyun
- Department of Engineering Sciences, Engineering FacultyIstanbul University‐Cerrahpasa Istanbul Turkey
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20
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Trama A, Botta L, Steliarova-Foucher E. Cancer Burden in Adolescents and Young Adults: A Review of Epidemiological Evidence. Cancer J 2019; 24:256-266. [PMID: 30480570 DOI: 10.1097/ppo.0000000000000346] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cancer burden in adolescents and young adults (AYAs) is expressed through a large proportion of the quality of life lost on individual level and also causes losses to the society in terms of a decreased productivity and social structure. A specific cancer spectrum and distinctive needs of AYA patients require targeted studies and cancer control measures. Incidence is intermediate between that for children and for older adults, and two-thirds of the AYA cancers affect women. Cancers of the breast and cervix uteri, representing a large portion of the burden, are amenable to prevention. Survival is relatively high, but it is lower in AYA patients with certain cancers that are common in childhood or older adulthood. Tailored cancer care with centralized multidisciplinary provision improves the outcome, as demonstrated by survival of leukemia patients. Mortality is decreasing in high-income countries for the cancers that contribute to the burden most, but lack of progress is seen for some rarer subtypes, such as brain tumors and sarcomas of the bone and soft tissue. There is unacceptable lack of information on cancer burden in low-income countries in which the outcomes for AYA patients are likely dreadful. Investment is required to establish cancer registration system and appropriate cancer care delivery in these settings.
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Affiliation(s)
| | | | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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21
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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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22
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Aldiss S, Fern LA, Phillips RS, Callaghan A, Dyker K, Gravestock H, Groszmann M, Hamrang L, Hough R, McGeachy D, Morgan S, Smith S, Upadhyaya S, Veitch H, Veitch L, Williamson M, Whelan JS, Gibson F. Research priorities for young people with cancer: a UK priority setting partnership with the James Lind Alliance. BMJ Open 2019; 9:e028119. [PMID: 31383701 PMCID: PMC6688702 DOI: 10.1136/bmjopen-2018-028119] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To conduct a UK-wide survey of young people who have experienced cancer, carers and professionals, to identify and prioritise research questions to inform decisions of research funders and support the case for research with this unique cancer population. DESIGN James Lind Alliance Priority Setting Partnership. SETTING UK health service and community. METHODS A steering group oversaw the initiative and partner organisations were recruited. Unanswered questions were collected in an online survey. Evidence searching verified uncertainties. An interim survey was used to rank questions prior to a final prioritisation workshop. PARTICIPANTS Young people aged 13-24 years with a current or previous cancer diagnosis, their families, friends, partners and professionals who work with this population. RESULTS Two hundred and ninety-two respondents submitted 855 potential questions. Following a refining process and removal of 'out of scope' questions, 208 unique questions remained. Systematic evidence checking identified seven answered questions and 16 were the subject of ongoing studies. The interim survey was completed by 174 participants. The top 30 questions were prioritised at a workshop attended by 25 young people, parents and multidisciplinary professionals. The top three priorities are: (1) What psychological support package improves psychological well-being, social functioning and mental health during and after treatment? (2) What interventions, including self-care, can reduce or reverse adverse short-term and long-term effects of cancer treatment? (3) What are the best strategies to improve access to clinical trials? The remaining questions reflect the complete cancer pathway: new therapies, life after cancer, support, education/employment, relapse and end-of-life care. CONCLUSIONS We have identified shared research priorities for young people with cancer using a rigorous, person-centred approach involving stakeholders typically not involved in setting the research agenda. The breadth of priorities suggest future research should focus on holistic and psychosocial care delivery as well as traditional drug/biology research.
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Affiliation(s)
- Susie Aldiss
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna A Fern
- Oncology Division, University College London Hospitals NHS Foundation Trust, London, UK
- Teenage, Young Adult and Germ Cell Clinical Studies Group, National Cancer Research Institute, London, UK
| | | | - Amy Callaghan
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Karen Dyker
- Oncology, Level 4, Bexley Wing, St James' University Hospital, Leeds, UK
| | | | - Michael Groszmann
- Paediatric & Adolescent Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Leila Hamrang
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Rachael Hough
- Children and Young Peoples Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Demi McGeachy
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Sue Morgan
- Teenage and Young Adult Cancer Service, Leeds General Infirmary, Leeds, UK
| | - Sam Smith
- Service Delivery, Teenage Cancer Trust, London, UK
| | - Sheela Upadhyaya
- The James Lind Alliance, National Institute for Health Research Evaluation, Southampton, UK
| | - Helen Veitch
- Service Delivery, Teenage Cancer Trust, London, UK
| | - Lara Veitch
- Teenage, Young Adult and Germ Cell Clinical Studies Group, National Cancer Research Institute, London, UK
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Max Williamson
- Teenage, Young Adult and Germ Cell Clinical Studies Group, National Cancer Research Institute, London, UK
- Teenage and Young Adult Cancer Priority Setting Partnership steering group, London, UK
| | - Jeremy S Whelan
- Oncology Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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23
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Pettit T, Sue L, Waugh V, Ballantine K, Gardner K, Bremer L, Pemberton L, Allison L, Adams S, Chou E, Spearing R. An Age Stratified Analysis of the Access to Care Continuum Across Three Tumor Groups: Are There Delays for AYA? J Adolesc Young Adult Oncol 2019; 8:402-409. [DOI: 10.1089/jayao.2018.0126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tristan Pettit
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Louise Sue
- South Island Adolescent and Young Adult Cancer Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Val Waugh
- South Island Adolescent and Young Adult Cancer Service, Southern District Health Board, Dunedin, New Zealand
| | - Kirsten Ballantine
- Children's Hematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Kate Gardner
- Department of Medical Oncology, Christchurch Hospital, Christchurch, New Zealand
| | - Louise Bremer
- Department of Medical Oncology and Dunedin Hospital, Dunedin, New Zealand
| | - Lucy Pemberton
- Department of Haematology, Dunedin Hospital, Dunedin, New Zealand
| | - Lucy Allison
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Savannah Adams
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Eunice Chou
- Division of Health Sciences, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ruth Spearing
- Department of Haematology, Christchurch Hospital, Christchurch, New Zealand
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24
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Smith L, Glaser AW, Peckham D, Greenwood DC, Feltbower RG. Respiratory morbidity in young people surviving cancer: Population-based study of hospital admissions, treatment-related risk factors and subsequent mortality. Int J Cancer 2019; 145:20-28. [PMID: 30549268 DOI: 10.1002/ijc.32066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 11/05/2022]
Abstract
Respiratory diseases are a major cause of late morbidity and mortality amongst childhood cancer survivors. This population-based study investigates respiratory hospital admissions in long-term survivors of cancers diagnosed in young people to identify specific respiratory morbidities, treatment-related risks and their relationship to subsequent morbidity and mortality. Population-based cancer registrations in Yorkshire, England, diagnosed between 1990 and 2011 aged 0-29 years, were linked to inpatient Hospital Episode Statistics (HES) for admissions up to 2017. All 5-year survivors were included in analysis (n = 4235). Admission rates were compared to age- and sex- matched general population rates. Competing risk regression models were used to assess associations between treatment exposures and risk of admission. Risk of death after admission was calculated using Cox regression. By age 40, cumulative incidence for an admission for any type of respiratory condition was 49%. Respiratory admission rates were 1.86 times higher in cancer survivors than in the general population (95% Confidence Interval (CI) 1.73-2.01), and varied by respiratory condition and age at diagnosis. Treatment with chemotherapy with known lung toxicity increased the risk of admission for all respiratory conditions (subdistribution Hazard ratio (sHR) = 1.26, 95%CI 1.03-1.53) and pneumonia (sHR = 1.48, 95%CI 1.01-2.17). Subsequent mortality was highest in those admitted for pneumonia compared to other respiratory conditions (28% and 15% respectively). Survivors of childhood and young adult cancer remain at significantly increased risk of respiratory complications several decades after treatment, emphasising the importance for clinical initiatives for prevention, early detection and treatment.
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Affiliation(s)
- Lesley Smith
- Clinical and Population Science Department, School of Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Adam W Glaser
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds, United Kingdom.,Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, United Kingdom
| | - Daniel Peckham
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darren C Greenwood
- Clinical and Population Science Department, School of Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Richard G Feltbower
- Clinical and Population Science Department, School of Medicine, University of Leeds, Leeds, United Kingdom.,Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
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25
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Sodergren SC, Husson O, Rohde GE, Tomaszewska IM, Griffiths H, Pessing A, Yarom N, Hooker L, Din A, Darlington AS. Does age matter? A comparison of health-related quality of life issues of adolescents and young adults with cancer. Eur J Cancer Care (Engl) 2019; 27:e12980. [PMID: 30485601 DOI: 10.1111/ecc.12980] [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] [Received: 08/21/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health-related quality of life (HRQoL) concerns of adolescents and young adults (AYAs) aged 14-25 years were compared with those of older adults (26-60 years) with cancer. METHODS AYAs and older adults receiving curative intent treatment or supportive palliative care for cancer were recruited from eight research centres across Europe. Participants used a rating scale to score the relevance and importance of a list of 77 issues covering 10 areas of HRQoL concern: symptoms; activity restrictions; social; emotional; body image; self-appraisals; outlook on life; lifestyle; treatment-related and life beyond treatment. RESULTS HRQoL issues were reviewed by 33 AYAs and 25 older adults. Several issues were recognised as relevant and important across all age groups: symptoms, emotional impact, outlook on life, lifestyle and treatment-related. A number of issues were more relevant or important to AYAs including interrupted education, greater motivation to achieve academic goals, increased maturity, boredom, fertility and change in living situation. CONCLUSION While there is overlap in several of the HRQoL concerns across the age span, it is important that HRQoL measures used with AYAs capture the diverse and unique psychosocial aspects of this developmental stage.
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Affiliation(s)
| | | | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | | | - Aya Pessing
- Department of Oral & Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam Yarom
- Department of Oral Pathology and Oral Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Louise Hooker
- Teenage and Young Adult Cancer Service, University Hospital Southampton, Southampton, UK
| | - Amy Din
- School of Health Sciences, University of Southampton, Southampton, UK
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26
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Choy B, Venkataraman G, Biernacka A, Lastra RR, Mueller J, Setia N, Reeves W, Antic T. Correlation of cytopathology with flow cytometry and histopathology for the diagnosis of hematologic malignancies in young adults presenting with cervical lymphadenopathy. Diagn Cytopathol 2019; 47:579-583. [PMID: 30794347 DOI: 10.1002/dc.24157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) is frequently utilized in the diagnostic workup of lymphadenopathy. We evaluated the correlation of cytopathology with flow cytometry and tissue biopsy results and assessed the prevalence of specific malignancies in young adults presenting with cervical lymphadenopathy. METHODS Database was searched for cervical lymph node FNA performed by a cytopathologist in patients aged 18-30 years from 2005 to 2017. RESULTS Cervical lymph node FNA was performed on 48 patients without prior history of malignancy. Nineteen patients had cytology results only, of which all were interpreted as benign reactive lymph node. None developed subsequent malignancies. The remaining 29 patients had cytology with flow cytometry and/or tissue biopsy results. A benign reactive cytology diagnosis was rendered in 18 (62%) cases, of which 11 had concordant diagnosis on flow cytometry, 2 had tissue biopsy, and 3 had both. Eleven (38%) patients had cytology results concerning for a hematologic malignancy, of which 7 were confirmed by flow cytometry and 3 by both flow cytometry and tissue biopsy. Cervical lymph node FNA has 94.1% sensitivity, 83.3% specificity, 88.9% positive predictive value, and 90.9% negative predictive value. The most common hematologic malignancy in our young adult population presenting with cervical lymphadenopathy was Hodgkin lymphoma. CONCLUSION FNA is a useful first-line diagnostic procedure for assessing cervical lymphadenopathy in young adults to allow for better triage of specimens for flow cytometry and/or tissue biopsy concerning for a hematologic malignancy and potentially avoid invasive excisional biopsy in a proportion of cases.
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Affiliation(s)
- Bonnie Choy
- Department of Pathology, University of Chicago, Chicago, Illinois.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Anna Biernacka
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Jeffery Mueller
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Namrata Setia
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Ward Reeves
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois
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27
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Högström G, Ohlsson H, Crump C, Sundquist J, Sundquist K. Aerobic fitness in late adolescence and the risk of cancer and cancer-associated mortality in adulthood: A prospective nationwide study of 1.2 million Swedish men. Cancer Epidemiol 2019; 59:58-63. [PMID: 30690331 DOI: 10.1016/j.canep.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of cancer has steadily risen. It is important to identify modifiable predictors in early life that may decrease cancer risks and mortality. The present study aims to investigate the relationship between aerobic fitness in adolescence and the subsequent risk of cancer and cancer-associated mortality. METHODS The study included 1 185 439 Swedish men born between 1950 and 1980 that participated in the military conscription (mean age = 18 years). The results from the aerobic fitness test (Wmax) was linked to the risk of cancer and cancer-associated mortality during a 40-years' follow-up using Cox proportional hazards models. A co-sibling design was employed to take familial factors into account. RESULTS During a mean follow-up of 27 years 15 093 cases of cancer and 4900 cancer-associated mortalities were registered. Higher Wmax (per additional 1 SD) was associated with a decreased risk of cancer at 40 years of follow-up (HR 0.93; 95% CI 0.91-0.96 for cancer and HR 0.82 95% CI 0.76-0.87 for cancer-associated mortality) but not at 5 years of follow-up (HR 1.03; 95% CI 0.99-1.07; and HR 1.04; 95% CI 0.97-1.12). In the co-sibling model the protective effects of high Wmax were increased at 40 years of follow-up for cancer (HR 0.91; 95% CI 0.85-0.98) and cancer-associated mortality (HR 0.78; 95% CI 0.68-0.89). CONCLUSIONS These findings identify in late adolescence a potentially modifiable predictor of cancer, with higher aerobic fitness associated with a decreased risk of cancer incidence and mortality later in life.
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Affiliation(s)
- G Högström
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Sandbäcksgatan 7, 582 25, Linköping, Sweden; Center for Primary Health Care Research, Lund University, Clinical Research Center, 202 13, Malmö, Sweden.
| | - H Ohlsson
- Center for Primary Health Care Research, Lund University, Clinical Research Center, 202 13, Malmö, Sweden.
| | - C Crump
- Center for Primary Health Care Research, Lund University, Clinical Research Center, 202 13, Malmö, Sweden; Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, Suite L5-40, New York, NY 10029, USA.
| | - J Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Center, 202 13, Malmö, Sweden.
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Center, 202 13, Malmö, Sweden.
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28
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Fidler MM, Reulen RC, Bright CJ, Henson KE, Kelly JS, Jenney M, Ng A, Whelan J, Winter DL, Frobisher C, Hawkins MM. Respiratory mortality of childhood, adolescent and young adult cancer survivors. Thorax 2018; 73:959-968. [PMID: 29748251 PMCID: PMC6166601 DOI: 10.1136/thoraxjnl-2017-210683] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 02/20/2018] [Accepted: 03/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exposure to radiation and/or chemotherapy during cancer treatment can compromise respiratory function. We investigated the risk of long-term respiratory mortality among 5-year cancer survivors diagnosed before age 40 years using the British Childhood Cancer Survivor Study (BCCSS) and Teenage and Young Adult Cancer Survivor Study (TYACSS). METHODS The BCCSS comprises 34 489 cancer survivors diagnosed before 15 years from 1940 to 2006 in Great Britain. The TYACSS includes 200 945 cancer survivors diagnosed between 15 years and 39 years from 1971 to 2006 in England and Wales. Standardised mortality ratios and absolute excess risks were used. FINDINGS Overall, 164 and 1079 respiratory deaths were observed in the BCCSS and TYACSS cohorts respectively, which was 6.8 (95% CI 5.8 to 7.9) and 1.7 (95% CI 1.6 to 1.8) times that expected, but the risks varied substantially by type of respiratory death. Greatest excess numbers of deaths were experienced after central nervous system (CNS) tumours in the BCCSS and after lung cancer, leukaemia, head and neck cancer and CNS tumours in the TYACSS. The excess number of respiratory deaths increased with increasing attained age, with seven (95% CI 2.4 to 11.3) excess deaths observed among those aged 50+ years in the BCCSS and three (95% CI 1.4 to 4.2) excess deaths observed among those aged 60+ years in the TYACSS. It was reassuring to see a decline in the excess number of respiratory deaths among those diagnosed more recently in both cohorts. CONCLUSIONS Prior to this study, there was almost nothing known about the risks of respiratory death after cancer diagnosed in young adulthood, and this study addresses this gap. These new findings will be useful for both survivors and those involved in their clinical management and follow-up.
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Affiliation(s)
- Miranda M Fidler
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chloe J Bright
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine E Henson
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Clinical Trial Service Unite, University of Oxford, Oxford, UK
| | - Julie S Kelly
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - Antony Ng
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Jeremy Whelan
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Clare Frobisher
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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29
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Roder DM, Warr A, Patterson P, Allison KR. Australian Adolescents and Young Adults: Trends in Cancer Incidence, Mortality, and Survival Over Three Decades. J Adolesc Young Adult Oncol 2018; 7:326-338. [DOI: 10.1089/jayao.2017.0095] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- David M. Roder
- Cancer Epidemiology Research Group, Centre for Population Research, Samson Institute for Health Research, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Pandora Patterson
- CanTeen Australia, Sydney, Australia
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
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30
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Nomellini PF, Curado MP, Oliveira MMD. Cancer Incidence in Adolescents and Young Adults in 24 Selected Populations of Latin America. J Adolesc Young Adult Oncol 2018; 7:164-173. [PMID: 29634431 DOI: 10.1089/jayao.2017.0088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Describe incidence rates for the most common cancers in Latin American adolescents and young adults (AYA). METHODS Incidence data were extracted from the Cancer Incidence in Five Continents series, available online (IARC). Age-standardized incidence rates and trend analysis were calculated. Trends were calculated by joinpoint regression analysis to obtain average annual percentage change values. RESULTS There were 22,990 invasive incident cancer cases in AYA between 1998 and 2007, obtained from 24 population-based cancer registries. The most common cancer in males was gonadal germ cell tumor, with incidence rates ranging from 1.7 to 7.0/100,000; in females the most common cancer was thyroid cancer, with rates ranging from 0.9 to 10.0/100,000. Incidence trends were limited to four regional populations and increased for all malignancies, in males from 1.8% to 3.4% and in females from 0.9% to 1.8%. CONCLUSIONS Cancer incidence rates in Latin American AYA are low. There are few PBCRs with long-term data, and therefore, the results herein presented are a partial view of cancer in Latin American AYA populations.
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Affiliation(s)
- Patrícia Ferreira Nomellini
- 1 Postgraduate Program in Health Sciences, Federal University of Goiás , Goiânia, Brazil .,2 Health Secretariat of the state of Tocantins , Palmas, Brazil .,3 Health Secretariat of the city of Palmas , Palmas, Brazil
| | - Maria Paula Curado
- 1 Postgraduate Program in Health Sciences, Federal University of Goiás , Goiânia, Brazil .,4 Epidemiology and Statistics Group, ACCamargo Cancer Center , São Paulo, Brazil .,5 International Prevention Research Institute , Lyon, France
| | - Max Moura de Oliveira
- 4 Epidemiology and Statistics Group, ACCamargo Cancer Center , São Paulo, Brazil .,6 Graduate Program in Public Health, School of Public Health, University of São Paulo , São Paulo, Brazil
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31
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Herbert A, Lyratzopoulos G, Whelan J, Taylor RM, Barber J, Gibson F, Fern LA. Diagnostic timeliness in adolescents and young adults with cancer: a cross-sectional analysis of the BRIGHTLIGHT cohort. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:180-190. [PMID: 29503844 PMCID: PMC5824669 DOI: 10.1016/s2352-4642(18)30004-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Adolescents and young adults (AYAs) are thought to experience prolonged intervals to cancer diagnosis, but evidence quantifying this hypothesis and identifying high-risk patient subgroups is insufficient. We aimed to investigate diagnostic timeliness in a cohort of AYAs with incident cancers and to identify factors associated with variation in timeliness. Methods We did a cross-sectional analysis of the BRIGHTLIGHT cohort, which included AYAs aged 12-24 years recruited within an average of 6 months from new primary cancer diagnosis from 96 National Health Service hospitals across England between July 1, 2012, and April 30, 2015. Participants completed structured, face-to-face interviews to provide information on their diagnostic experience (eg, month and year of symptom onset, number of consultations before referral to specialist care); demographic information was extracted from case report forms and date of diagnosis and cancer type from the national cancer registry. We analysed these data to assess patient interval (time from symptom onset to first presentation to a general practitioner [GP] or emergency department), the number of prereferral GP consultations, and the symptom onset-to-diagnosis interval (time from symptom onset to diagnosis) by patient characteristic and cancer site, and examined associations using multivariable regression models. Findings Of 1114 participants recruited to the BRIGHTLIGHT cohort, 830 completed a face-to-face interview. Among participants with available information, 204 (27%) of 748 had a patient interval of more than a month and 242 (35%) of 701 consulting a general practitioner had three or more prereferral consultations. The median symptom onset-to-diagnosis interval was 62 days (IQR 29-153). Compared with male AYAs, female AYAs were more likely to have three or more consultations (adjusted odds ratio [OR] 1·6 [95% CI 1·1-2·3], p=0·0093) and longer median symptom onset-to-diagnosis intervals (adjusted median interval longer by 24 days [95% CI 11-37], p=0·0005). Patients with lymphoma or bone tumours (adjusted OR 1·2 [95% CI 0·6-2·1] compared with lymphoma) were most likely to have three or more consultations and those with melanoma least likely (0·2 [0·1-0·7] compared with lymphoma). The adjusted median symptom onset-to-diagnosis intervals were longest in AYAs with bone tumours (51 days [95% CI 29-73] longer than for lymphoma) and shortest in those with leukaemia (33 days [17-49] shorter than for lymphoma). Interpretation The findings provide a benchmark for diagnostic timeliness in young people with cancer and help to identify subgroups at higher risk of a prolonged diagnostic journey. Further research is needed to understand reasons for these findings and to prioritise and stratify early diagnosis initiatives for AYAs. Funding National Institute for Health Research, Teenage Cancer Trust, and Cancer Research UK.
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Affiliation(s)
- Annie Herbert
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Sciences & Health, University College London, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Sciences & Health, University College London, London, UK
| | - Jeremy Whelan
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rachel M Taylor
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Lorna A Fern
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
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32
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Gupta N, Chitalkar P, Mishra R, Punia A. Epidemiology of cancer in young in central India: An analysis of rural cancer hospital data. South Asian J Cancer 2018; 6:183-185. [PMID: 29404302 PMCID: PMC5763634 DOI: 10.4103/sajc.sajc_132_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Cancers in teenage and young adults (TYAs), though an increasing cause of mortality in our country, have been scarcely studied. The lack of studies of TYAs can significantly affect the outcomes of the youth in the prime of their lives. Aims: The aim of this study was to study the type of cancers in the TYA at a rural cancer center in central India. Design and Methods: A prospective study in the department of medical oncology, from the period of January 2013 till March 2016, was done. Data regarding socioepidemiological factors were collected for new cancer patients between the age group of 15–30 years in semi-structured questionnaire and from the hospital records. Cancers were classified according to the Birch classification. The cases were analyzed according to the epidemiological profile, classification of cancer, and age-wise distribution using descriptive analysis. Results: In this study, out of 5221 cancer patients, TYAs accounted for 327 (6.26%) with 189 males and 138 females (M: F– 1.37:1). The maximum cases were seen in 25–30 years’ age group. Carcinoma was the most common malignancy (54.74%) with an increase from 19.56% in the 15–19 years’ age group to 64.82% in the 25–30-year-old patients. Conclusion: The present study gives a glimpse of the TYA cancers in the central India. More than half of the young cancer patients suffer from carcinomas with about half of these being head and neck cancers.
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Affiliation(s)
- Novak Gupta
- Department of Medical Oncology, Sri Aurobindo Medical College and P. G. Institute, Indore, Madhya Pradesh, India
| | - Prakash Chitalkar
- Department of Medical Oncology, Sri Aurobindo Medical College and P. G. Institute, Indore, Madhya Pradesh, India
| | - Renu Mishra
- Department of Medical Oncology, Sri Aurobindo Medical College and P. G. Institute, Indore, Madhya Pradesh, India
| | - Ankur Punia
- Department of Medical Oncology, Sri Aurobindo Medical College and P. G. Institute, Indore, Madhya Pradesh, India
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33
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Fidler MM, Steliarova-Foucher E, Soerjomataram I, Ferlay J, Gupta S, Bray F. Young adults: a unique group in cancer epidemiological research - Authors' reply. Lancet Oncol 2018; 19:e73. [PMID: 29413474 DOI: 10.1016/s1470-2045(18)30032-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Miranda M Fidler
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, 69372 CEDEX 08, France.
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, 69372 CEDEX 08, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, 69372 CEDEX 08, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, 69372 CEDEX 08, France
| | - Sumit Gupta
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, 69372 CEDEX 08, France
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34
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Kerner JF, Cazap E, Yach D, Pierotti MA, Daidone MG, de Blasio P, Geary P, Schacter B, Sant M, Habbema JDF, Sankaranarayanan R, Sutcliffe C, Sutcliffe S. Comprehensive cancer control-research & development: knowing what we do and doing what we know. TUMORI JOURNAL 2018; 95:610-22. [DOI: 10.1177/030089160909500504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Comprehensive cancer control is defined as an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality across the cancer control continuum from primary prevention to end-of-life care. This approach assumes that when the public sector, non-governmental organizations, academia, and the private sector share with each other their skills, knowledge, and resources, a country can take advantage of all its talents and resources to more quickly reduce the burden of cancer for all its population. One critical issue for comprehensive cancer control is the extent to which the private sector can contribute to cancer prevention and control programs and policies that have historically been lead by the public health sector, and similarly how can the public sector increase its investment and involvement in clinical research and practice issues that are largely driven by the private sector worldwide? In addition, building capacity to integrate research that is appropriate to the culture and context of the population will be important in different settings, in particular research related to cancer control interventions that have the capacity to influence outcomes. To whatever extent cancer control research is ultimately funded through the private and public sectors, if investments in research discoveries are ultimately to benefit the populations that bear the greatest burden of disease, then new approaches to integrating the lessons learned from science with the lessons learned from service (public health, clinical, and public policy) must be found to close the gap between what we know and what we do. Communities of practice for international cancer control, like the ones fostered by the first three International Cancer Control Congresses, represent an important forum for knowledge exchange opportunities to accelerate the translation of new knowledge into action to reduce the burden of cancer worldwide.
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Affiliation(s)
- Jon F Kerner
- Canadian Partnership Against Cancer, Toronto, Canada
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncologia Medica (SLACOM), Buenos Aires, Argentina
| | | | | | | | | | - Peter Geary
- Canadian Tumor Repository Network, Manitoba, Canada
| | | | - Milena Sant
- Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - J Dik F Habbema
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Simon Sutcliffe
- Canadian Partnership Against Cancer Board of Directors, Vancouver, Canada
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Fidler MM, Gupta S, Soerjomataram I, Ferlay J, Steliarova-Foucher E, Bray F. Cancer incidence and mortality among young adults aged 20-39 years worldwide in 2012: a population-based study. Lancet Oncol 2017; 18:1579-1589. [PMID: 29111259 DOI: 10.1016/s1470-2045(17)30677-0] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the burden of cancer among young adults has rarely been studied in depth. Our aim was to describe the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographical region. METHODS We did a population-based study to quantify the burden of young adult cancers worldwide. We defined young adult cancers as those occurring between the ages of 20 and 39 years because these individuals will have passed puberty and adolescence, but not yet experienced the effects of hormonal decline, immune response deterioration, or organ dysfunction associated with chronic health conditions. Global, regional, and country-specific (n=184) data estimates of the number of new cancer cases and cancer-associated deaths that occurred in 2012 among young adults were extracted in four 5-year bands from the International Agency for Research on Cancer's GLOBOCAN 2012 for all cancers combined and for 27 major types as defined by the International Classification of Disease, tenth revision. We report the number of new cancer cases and cancer-associated deaths overall and by sex alongside corresponding age-standardised rates (ASR) per 100 000 people per year. We also present results using four levels of the Human Development Index (HDI; low [least developed], medium, high, and very high [most developed]), which is a composite indicator for socioeconomic development comprising life expectancy, education, and gross national income. FINDINGS 975 396 new cancer cases and 358 392 cancer-associated deaths occurred among young adults worldwide in 2012, which equated to an ASR of 43·3 new cancer cases per 100 000 people per year and 15·9 cancer-associated deaths per 100 000 people per year. The burden was disproportionally greater among women and the most common cancer types overall in terms of new cases were female breast cancer, cervical cancer, thyroid cancer, leukaemia, and colorectal cancer; in terms of deaths, female breast cancer, liver cancer, leukaemia, and cervical cancer were the main contributors. When assessed by development level and geographical region, the cancer profile varied substantially; generally, the burden of infection-associated cancers was greater in regions under transition. Cancer incidence was elevated in very high-HDI regions compared with low-HDI regions (ASR 64·5 vs 46·2 cancer cases per 100 000 people per year); however, the mortality burden was 3 times higher in low-HDI regions (ASR 25·4 vs 9·2 cancer-associated deaths per 100 000 people per year), reflecting differences in cancer profiles and inferior outcomes. INTERPRETATION The global cancer burden among 20-39 year-olds differs from that seen in younger or older ages and varies substantially by age, sex, development level, and geographical region. Although the cancer burden is lower in this age group than that observed in older ages, the societal and economic effects remain great given the major effects of premature morbidity and mortality. Targeted surveillance, prevention, and treatment are needed to reduce the cancer burden in this underserved age group. FUNDING International Agency for Research on Cancer (IARC) and European Commission's FP-7 Marie Curie Actions-People-COFUND.
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Affiliation(s)
- Miranda M Fidler
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Sumit Gupta
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Reedijk AMJ, van der Heiden-van der Loo M, Visser O, Karim-Kos HE, Lieverst JA, de Ridder-Sluiter JG, Coebergh JWW, Kremer LC, Pieters R. Site of childhood cancer care in the Netherlands. Eur J Cancer 2017; 87:38-46. [PMID: 29107860 DOI: 10.1016/j.ejca.2017.09.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the complexity of diagnosis and treatment, care for children and young adolescents with cancer preferably occurs in specialised paediatric oncology centres with potentially better cure rates and minimal late effects. This study assessed where children with cancer in the Netherlands were treated since 2004. METHODS All patients aged under 18 diagnosed with cancer between 2004 and 2013 were selected from the Netherlands Cancer Registry (NCR) and linked with the Dutch Childhood Oncology Group (DCOG) database. Associations between patient and tumour characteristics and site of care were tested statistically with logistic regression analyses. RESULTS This population-based study of 6021 children diagnosed with cancer showed that 82% of them were treated in a paediatric oncology centre. Ninety-four percent of the patients under 10 years of age, 85% of the patients aged 10-14 and 48% of the patients aged 15-17 were treated in a paediatric oncology centre. All International Classification of Childhood Cancers (ICCC), 3rd edition, ICCC-3 categories, except embryonal tumours, were associated with a higher risk of treatment outside a paediatric oncology centre compared to leukaemia. Multivariable analyses by ICCC-3 category revealed that specific tumour types such as chronic myelogenous leukaemia (CML), embryonal carcinomas, bone tumours other type than osteosarcoma, non-rhabdomyosarcomas, thyroid carcinomas, melanomas and skin carcinomas as well as lower-staged tumours were associated with treatment outside a paediatric oncology centre. CONCLUSION The site of childhood cancer care in the Netherlands depends on the age of the cancer patient, type of tumour and stage at diagnosis. Collaboration between paediatric oncology centre(s), other academic units is needed to ensure most up-to-date paediatric cancer care for childhood cancer patients at the short and long term.
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Affiliation(s)
- A M J Reedijk
- Princess Máxima Center for Pediatric Oncology, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands; Dutch Childhood Oncology Group, Zinkwerf 5-7, The Hague 2544 EC, The Netherlands.
| | - M van der Heiden-van der Loo
- Princess Máxima Center for Pediatric Oncology, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands; Dutch Childhood Oncology Group, Zinkwerf 5-7, The Hague 2544 EC, The Netherlands
| | - O Visser
- Comprehensive Cancer Organization the Netherlands, Godebaldkwartier 419, Utrecht 3511 DT, The Netherlands
| | - H E Karim-Kos
- Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - J A Lieverst
- Dutch Childhood Oncology Group, Zinkwerf 5-7, The Hague 2544 EC, The Netherlands
| | | | - J W W Coebergh
- Department of Public Health, Erasmus MC University Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - L C Kremer
- Princess Máxima Center for Pediatric Oncology, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands; Dutch Childhood Oncology Group, Zinkwerf 5-7, The Hague 2544 EC, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - R Pieters
- Princess Máxima Center for Pediatric Oncology, Uppsalalaan 8, Utrecht 3584 CT, The Netherlands
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Georgakis MK, Panagopoulou P, Papathoma P, Tragiannidis A, Ryzhov A, Zivkovic-Perisic S, Eser S, Taraszkiewicz Ł, Sekerija M, Žagar T, Antunes L, Zborovskaya A, Bastos J, Florea M, Coza D, Demetriou A, Agius D, Strahinja RM, Sfakianos G, Nikas I, Kosmidis S, Razis E, Pourtsidis A, Kantzanou M, Dessypris N, Petridou ET. Central nervous system tumours among adolescents and young adults (15–39 years) in Southern and Eastern Europe: Registration improvements reveal higher incidence rates compared to the US. Eur J Cancer 2017; 86:46-58. [DOI: 10.1016/j.ejca.2017.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/30/2022]
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Saloustros E, Stark DP, Michailidou K, Mountzios G, Brugieres L, Peccatori FA, Jezdic S, Essiaf S, Douillard JY, Bielack S. The care of adolescents and young adults with cancer: results of the ESMO/SIOPE survey. ESMO Open 2017; 2:e000252. [PMID: 29018578 PMCID: PMC5604713 DOI: 10.1136/esmoopen-2017-000252] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Adolescents and young adults (AYA) with cancer require dedicated clinical management and care. Little is known about the training and practice of European healthcare providers in regard to AYA and the availability of specialised services. Methods A link to an online survey was sent to members of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). The link was also sent to ESMO National Representatives and circulated to other European oncology groups. Questions covered the demographics and clinical training of respondents, their definition of AYA, education about AYA cancer, access to specialised clinical and supportive care, research and further education. Data from Europe were analysed by region. Results Three hundred tweenty two questionnaires were submitted and we focused on data from the 266 European healthcare professionals. Responses revealed considerable variation both within and between countries in the definition of AYA. Over two-thirds of respondents did not have access to specialised centres for AYA (67%), were not aware of research initiatives focusing on AYA with cancer (69%) and had no access to specialist services for managing the late effects of treatment (67%). The majority of the respondents were able to refer AYA patients to professional psychological support and specialised social workers. However, more than half had no access to an age-specialised nurse or specialised AYA education. Overall, 38% of respondents reported that their AYA patients did not have access to fertility specialists. This figure was 76% in Eastern Europe. Lack of specialised AYA care was particularly evident in Eastern and South-Eastern Europe. Conclusion There is important underprovision and inequity of AYA cancer care across Europe. Improving education and research focused on AYA cancer care should be a priority.
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Affiliation(s)
- Emmanouil Saloustros
- Oncology Unit, General Hospital of Heraklion 'Venizelio', Heraklion, Crete, Greece
| | | | | | - Giannis Mountzios
- Department of Medical Oncology, 251 General Airforce Hospital, Athens, Greece
| | | | - Fedro Alessandro Peccatori
- Fertility & Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy
| | - Svetlana Jezdic
- European Society for Medical Oncology, Viganello-Lugano, Switzerland
| | - Samira Essiaf
- European Society for Paediatric Oncology (SIOPE), Brussels, Belgium
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Sodergren SC, Husson O, Robinson J, Rohde GE, Tomaszewska IM, Vivat B, Dyar R, Darlington AS. Systematic review of the health-related quality of life issues facing adolescents and young adults with cancer. Qual Life Res 2017; 26:1659-1672. [PMID: 28251543 PMCID: PMC5486886 DOI: 10.1007/s11136-017-1520-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE For adolescents and young adults (AYAs), the impact of a cancer diagnosis and subsequent treatment is likely to be distinct from other age groups given the unique and complex psychosocial challenges of this developmental phase. In this review of the literature, we report the health-related quality of life (HRQoL) issues experienced by AYAs diagnosed with cancer and undergoing treatment. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and the Cochrane Library Databases were searched for publications reporting HRQoL of AYAs. Issues generated from interviews with AYAs or from responses to patient reported outcome measures (PROMs) were extracted. RESULTS 166 papers were reviewed in full and comprised 72 papers covering 69 primary studies, 49 measurement development or evaluation papers and 45 reviews. Of the 69 studies reviewed, 11 (16%) used interviews to elicit AYAs' descriptions of HRQoL issues. The majority of the PROMs used in the studies represent adaptations of paediatric or adult measures. HRQoL issues were organised into the following categories: physical, cognitive, restricted activities, relationships with others, fertility, emotions, body image and spirituality/outlook on life. CONCLUSION The HRQoL issues presented within this review are likely to be informative to health care professionals and AYAs. The extensive list of issues suggests that the impact of a cancer diagnosis and treatment during adolescence and young adulthood is widespread and reflects the complexities of this developmental phase.
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Affiliation(s)
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jessica Robinson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Gudrun E Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Iwona M Tomaszewska
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Bella Vivat
- Marie Curie Palliative Care Research Department and Division of Psychiatry, University College London, London, UK
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de Jesus VHF, Ribeiro TN, Chinen LTD, Alves V, Curado MP, Fanelli MF. Epidemiological Profile and Treatment Outcomes in Young Adults (19-29 Years of Age) Treated for Cancer in a Tertiary Hospital in São Paulo, Brazil. J Adolesc Young Adult Oncol 2017; 6:333-340. [PMID: 28422548 DOI: 10.1089/jayao.2016.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Worldwide, the incidence of cancer in young adults (20-39 years) is increasing, and represents an important cause of mortality in this age group. A retrospective study was undertaken to provide information that may lead to improved treatment outcomes. METHODS Epidemiological, clinicopathological, treatment, and survival information were retrieved from the electronic database registry of a tertiary referral hospital in São Paulo, Brazil for patients 19-29 years of age diagnosed with cancer between January 2007 and December 2012. RESULTS There were 960 patients with a median age at diagnosis of 26 years; female patients comprised 59.2%. A previous diagnosis of malignancy was present in 2.3%; 0.4% had malignant tumors that were radiation-associated; regular alcohol use was present in 10.4%; 9% of patients reported tobacco use; a family history of cancer was present in 41.7%. Malignant tumors included carcinomas (45.7%), germ cell and trophoblastic neoplasms (12.3%), and lymphomas (12.1%). Median follow-up was 47.7 months (range: 0.62-100.9 months) during which time 111 patients (13.5%) died. Carcinomas (n = 43, 38.7%), soft tissue sarcomas (n = 18, 16.2%), and leukemias (n = 10, 9.0%) were the most common causes of death. CONCLUSIONS This study has shown that carcinomas represent the most common malignancy in adolescents and young adults referred to a tertiary cancer center in Brazil and are the most common cause of mortality. Because clinical outcome may be affected by multiple factors in this patient population, further global studies are needed to characterize this population and improve clinical care.
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Affiliation(s)
| | - Taynan Nunes Ribeiro
- 1 Department of Medical Oncology, A.C. Camargo Cancer Center , São Paulo, Brazil
| | | | - Vanessa Alves
- 2 International Research Center, A.C. Camargo Cancer Center , São Paulo, Brazil
| | - Maria Paula Curado
- 2 International Research Center, A.C. Camargo Cancer Center , São Paulo, Brazil
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Bright CJ, Hawkins MM, Guha J, Henson KE, Winter DL, Kelly JS, Feltbower RG, Hall M, Cutter DJ, Edgar AB, Frobisher C, Reulen RC. Risk of Cerebrovascular Events in 178 962 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The TYACSS (Teenage and Young Adult Cancer Survivor Study). Circulation 2017; 135:1194-1210. [PMID: 28122884 PMCID: PMC7614827 DOI: 10.1161/circulationaha.116.025778] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Survivors of teenage and young adult cancer are at risk of cerebrovascular events, but the magnitude of and extent to which this risk varies by cancer type, decade of diagnosis, age at diagnosis, and attained age remains uncertain. This is the largest-ever cohort study to evaluate the risks of hospitalization for a cerebrovascular event among long-term survivors of teenage and young adult cancer. METHODS The population-based TYACSS (Teenage and Young Adult Cancer Survivor Study) (N=178,962) was linked to Hospital Episode Statistics data for England to investigate the risks of hospitalization for a cerebrovascular event among 5-year survivors of cancer diagnosed when 15 to 39 years of age. Observed numbers of first hospitalizations for cerebrovascular events were compared with that expected from the general population using standardized hospitalization ratios (SHRs) and absolute excess risks per 10 000 person-years. Cumulative incidence was calculated with death considered a competing risk. RESULTS Overall, 2782 cancer survivors were hospitalized for a cerebrovascular event-40% higher than expected (SHR=1.4, 95% confidence interval, 1.3-1.4). Survivors of central nervous system (CNS) tumors (SHR=4.6, 95% confidence interval, 4.3-5.0), head and neck tumors (SHR=2.6, 95% confidence interval, 2.2-3.1), and leukemia (SHR=2.5, 95% confidence interval, 1.9-3.1) were at greatest risk. Males had significantly higher absolute excess risks than females (absolute excess risks =7 versus 3), especially among head and neck tumor survivors (absolute excess risks =30 versus 11). By 60 years of age, 9%, 6%, and 5% of CNS tumor, head and neck tumor, and leukemia survivors, respectively, had been hospitalized for a cerebrovascular event. Beyond 60 years of age, every year, 0.4% of CNS tumor survivors were hospitalized for a cerebral infarction (versus 0.1% expected), whereas at any age, every year, 0.2% of head and neck tumor survivors were hospitalized for a cerebral infarction (versus 0.06% expected). CONCLUSIONS Survivors of a CNS tumor, head and neck tumor, and leukemia are particularly at risk of hospitalization for a cerebrovascular event. The excess risk of cerebral infarction among CNS tumor survivors increases with attained age. For head and neck tumor survivors, this excess risk remains high across all ages. These groups of survivors, particularly males, should be considered for surveillance of cerebrovascular risk factors and potential pharmacological interventions for cerebral infarction prevention.
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Affiliation(s)
- Chloe J Bright
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Mike M Hawkins
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Joyeeta Guha
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Katherine E Henson
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - David L Winter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Julie S Kelly
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Richard G Feltbower
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Marlous Hall
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - David J Cutter
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Angela B Edgar
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Clare Frobisher
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.)
| | - Raoul C Reulen
- From Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Science, University of Birmingham, UK (C.J.B., M.M.H., J.G., D.L.W., J.S.K., C.F., R.C.R.); Public Health England, Birmingham, UK (J.G.); Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, UK (K.E.H., D.J.C.); Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, UK (R.G.F., M.H.); and Royal Hospital for Sick Children, Edinburgh, UK (A.B.E.).
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de Oliveira C, Bremner KE, Liu N, Greenberg ML, Nathan PC, McBride ML, Krahn MD. Costs for Childhood and Adolescent Cancer, 90 Days Prediagnosis and 1 Year Postdiagnosis: A Population-Based Study in Ontario, Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:345-356. [PMID: 28292479 DOI: 10.1016/j.jval.2016.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/04/2016] [Accepted: 10/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Childhood and adolescent cancers are uncommon, but they have important economic and health impacts on patients, families, and health care systems. Few studies have measured the economic burden of care for childhood and adolescent cancers. OBJECTIVES To estimate costs of cancer care in population-based cohorts of children and adolescents from the public payer perspective. METHODS We identified patients with cancer, aged 91 days to 19 years, diagnosed from 1995 to 2009 using cancer registry data, and matched each to three noncancer controls. Using linked administrative health care records, we estimated total and net resource-specific costs (in 2012 Canadian dollars) during 90 days prediagnosis and 1 year postdiagnosis. RESULTS Children (≤14 years old) numbered 4,396: 36% had leukemia, 21% central nervous system tumors, 10% lymphoma, and 33% other cancers. Adolescents (15-19 years old) numbered 2,329: 28.9% had lymphoma. Bone and soft tissue sarcoma, germ cell tumor, and thyroid carcinoma each comprised 12% to 13%. Mean net prediagnosis costs were $5,810 and $1,127 and mean net postdiagnosis costs were $136,413 and $62,326 for children and adolescents, respectively; the highest were for leukemia ($157,764 for children and $172,034 for adolescents). In both cohorts, costs were much higher for patients who died within 1 year of diagnosis. Inpatient hospitalization represented 69% to 74% of postdiagnosis costs. CONCLUSIONS Treating children with cancer is costly, more costly than treating adolescents or adults. Substantial survival gains in children mean that treatment may still be very cost-effective. Comprehensive age-specific population-based cost estimates are essential to reliably assess the cost-effectiveness of cancer care for children and adolescents, and measure health system performance.
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Affiliation(s)
- Claire de Oliveira
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Mark L Greenberg
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mary L McBride
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray D Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Burkhamer J, Kriebel D, Clapp R. The increasing toll of adolescent cancer incidence in the US. PLoS One 2017; 12:e0172986. [PMID: 28235028 PMCID: PMC5325567 DOI: 10.1371/journal.pone.0172986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/12/2017] [Indexed: 11/29/2022] Open
Abstract
Cancer incidence is rising among adolescents (“teens”). The causes of the increase are unknown but studying incidence patterns and trends may produce insights into etiology. Using data from the US National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program we described trends of cancer incidence among teens (15–19 year olds). We reviewed and summarized incidence patterns for histologic cancer groups and the most frequently diagnosed sites of cancer among teens during 2008–2012 reported by the SEER Cancer Statistics Review. We calculated annual incidence rates for the years 1975–2012 and used linear regression analysis to evaluate trends and calculate rates of change. Incidence for all sites combined increased annually by 0.67% for males and 0.62% for females during the period 1975 through 2012 –resulting in more than a 25% increase over 38 years. The biggest annual incidence increases occurred in non-Hodgkin lymphoma (NHL) (2.16% females; 1.38% males), thyroid cancer (2.12% females; 1.59% males), acute myeloid leukemia (AML) (1.73% females) and testicular cancer (1.55% males). Incidence rates for most histologic groups and sites showed steady long term increases over the 38 years of data. Despite improvements in survival, rising incidence trends mean growing numbers of young adults are undergoing painful and costly cancer treatments. A concerted research program is vital to investigate causes of steadily rising teen cancer rates.
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Affiliation(s)
- Jessica Burkhamer
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, United States of America
- * E-mail:
| | - David Kriebel
- Department of Public Health, University of Massachusetts, Lowell, Massachusetts, United States of America
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
| | - Richard Clapp
- Lowell Center for Sustainable Production, University of Massachusetts Lowell, Lowell, Massachusetts, United States of America
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Tseng OL, Spinelli JJ, Dawes M, McBride ML. Cervical cancer screening for survivors diagnosed with cancer before age 25. J Cancer Surviv 2017; 11:410-419. [PMID: 28127670 DOI: 10.1007/s11764-017-0598-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aims to better understand Pap test utilization for cancer survivors diagnosed before age 25 in British Columbia (BC), Canada. METHODS A population-based cross-sectional data linkage study that included 1285 5-year female cancer survivors diagnosed with cancer before age 25 and 12,185 randomly selected and birth-year-matched BC female residents. Pap participation rates in 2008-2010, both uncorrected and corrected for hysterectomy status, were compared between two groups. Adjusted prevalence ratios (PRadj) were calculated to examine (1) associations between factors and Pap rates in each group and (2) interactions between factors and groups, using log-binomial regression models. RESULTS Overall Pap rates, both uncorrected and corrected, were higher for survivors (71.8%; 72.9%) than population (69%; 69.7%). Pap rates were 4.8-5.1 and 17.8-22.4% higher for survivors aged 30-39 and 50-59 respectively. Significantly higher Pap test utilization was associated with previous Pap tests (PRadj = 1.83, 95%CI = 1.76-1.89) and previous cervical procedures (1.20, 95%CI = 1.15-1.25). Hysterectomy rates were doubled for survivors (7.4%) than population (3.7%). This did not affect Pap participation rate comparisons between two groups. In both groups, 51.6-70% of females with hysterectomies still received Pap tests. CONCLUSION Survivors' Pap test utilization was significantly higher than population, but lower than the Canadian benchmark of 90%. Hysterectomy correction does not affect this observation. Cervical cancer screening is suboptimal for survivors. Females with prior hysterectomies might have received unnecessary Pap tests. IMPLICATIONS FOR CANCER SURVIVORS Survivors without prior hysterectomies should continue to undergo Pap tests recommended by provincial guidelines, to optimize their health.
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Affiliation(s)
- Olivia L Tseng
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada. .,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
| | - John J Spinelli
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada.,Department of Statistics, Simon Fraser University, Burnaby, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary L McBride
- Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Henson KE, Reulen RC, Winter DL, Bright CJ, Fidler MM, Frobisher C, Guha J, Wong KF, Kelly J, Edgar AB, McCabe MG, Whelan J, Cutter DJ, Darby SC, Hawkins MM. Cardiac Mortality Among 200 000 Five-Year Survivors of Cancer Diagnosed at 15 to 39 Years of Age: The Teenage and Young Adult Cancer Survivor Study. Circulation 2016; 134:1519-1531. [PMID: 27821538 PMCID: PMC5106083 DOI: 10.1161/circulationaha.116.022514] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Survivors of teenage and young adult cancer are acknowledged as understudied. Little is known about their long-term adverse health risks, particularly of cardiac disease that is increased in other cancer populations where cardiotoxic treatments have been used. Methods: The Teenage and Young Adult Cancer Survivor Study cohort comprises 200 945 5-year survivors of cancer diagnosed at 15 to 39 years of age in England and Wales from 1971 to 2006, and followed to 2014. Standardized mortality ratios, absolute excess risks, and cumulative risks were calculated. Results: Two thousand sixteen survivors died of cardiac disease. For all cancers combined, the standardized mortality ratios for all cardiac diseases combined was greatest for individuals diagnosed at 15 to 19 years of age (4.2; 95% confidence interval, 3.4–5.2) decreasing to 1.2 (95% confidence interval, 1.1–1.3) for individuals aged 35 to 39 years (2P for trend <0.0001). Similar patterns were observed for both standardized mortality ratios and absolute excess risks for ischemic heart disease, valvular heart disease, and cardiomyopathy. Survivors of Hodgkin lymphoma, acute myeloid leukaemia, genitourinary cancers other than bladder cancer, non-Hodgkin lymphoma, lung cancer, leukaemia other than acute myeloid, central nervous system tumour, cervical cancer, and breast cancer experienced 3.8, 2.7, 2.0, 1.7, 1.7, 1.6, 1.4, 1.3 and 1.2 times the number of cardiac deaths expected from the general population, respectively. Among survivors of Hodgkin lymphoma aged over 60 years, almost 30% of the total excess number of deaths observed were due to heart disease. Conclusions: This study of over 200 000 cancer survivors shows that age at cancer diagnosis was critical in determining subsequent cardiac mortality risk. For the first time, risk estimates of cardiac death after each cancer diagnosed between the ages of 15 and 39 years have been derived from a large population-based cohort with prolonged follow-up. The evidence here provides an initial basis for developing evidence-based follow-up guidelines.
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Affiliation(s)
- Katherine E Henson
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Raoul C Reulen
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David L Winter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Chloe J Bright
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Miranda M Fidler
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Clare Frobisher
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Joyeeta Guha
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Kwok F Wong
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Julie Kelly
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Angela B Edgar
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Martin G McCabe
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Jeremy Whelan
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - David J Cutter
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Sarah C Darby
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D)
| | - Mike M Hawkins
- From Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (K.E.H., D.J.C., S.C.D.); Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Edgbaston, United Kingdom (K.E.H., R.C.R., D.L.W., C.J.B., M.M.F., C.F., J.G., K.F.W., J.K., M.M.H.); Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, University of Edinburgh, United Kingdom (A.B.E.); Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre (M.C.M.); National Institute for Health Research University College London Hospitals Biomedical Research Centre, United Kingdom (J.W.); and British Heart Foundation Centre for Research Excellence (D.J.C, S.C.D).
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Stark D, Rosenberg AR, Johnston D, Knight K, Caperon L, Uleryk E, Frazier AL, Sung L. Patient-Reported Measures of Hearing Loss and Tinnitus in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:1247-1252. [PMID: 27603148 PMCID: PMC5962920 DOI: 10.1044/2016_jslhr-h-15-0363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/04/2016] [Indexed: 05/15/2023]
Abstract
PURPOSE We identified studies that described use of any patient-reported outcome scale for hearing loss or tinnitus among children and adolescents and young adults (AYAs) with cancer or hematopoietic stem cell transplantation (HSCT) recipients. METHOD In this systematic review, we performed electronic searches of OvidSP MEDLINE, EMBASE, and PsycINFO to August 2015. We included studies if they used any patient-reported scale of hearing loss or tinnitus among children and AYAs with cancer or HSCT recipients. Only English language publications were included. Two reviewers identified studies and abstracted data. RESULTS There were 953 studies screened; 6 met eligibility criteria. All studies administered hearing patient-reported outcomes only once, after therapy completion. None of the studies described the psychometric properties of the hearing-specific component. Three instruments (among 6 studies) were used: Health Utilities Index (Barr et al., 2000; Fu et al., 2006; Kennedy et al., 2014), Hearing Measurement Scales (Einar-Jon et al., 2011; Einarsson et al., 2011), and the Tinnitus Questionnaire for Auditory Brainstem Implant (Soussi & Otto, 1994). All had limitations, precluding routine use for hearing assessment in this population. CONCLUSIONS We identified few studies that included hearing patient-reported measures for children and AYA cancer and HSCT patients. None are ideal to take forward into future studies. Future work should focus on the creation of a new psychometrically sound instrument for hearing outcomes in this population.
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Affiliation(s)
- Daniel Stark
- Section of Oncology and Cancer Research, Leeds Institute of Molecular Medicine, University of Leeds, United Kingdom
| | | | - Donna Johnston
- Division of Paediatric Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin Knight
- Pediatric Audiology, Oregon Health and Science University, Portland
| | - Lizzie Caperon
- Scholarly Communications and Researcher Skills, University of Leeds, United Kingdom
| | | | | | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Trama A, Botta L, Foschi R, Ferrari A, Stiller C, Desandes E, Maule MM, Merletti F, Gatta G. Survival of European adolescents and young adults diagnosed with cancer in 2000-07: population-based data from EUROCARE-5. Lancet Oncol 2016; 17:896-906. [PMID: 27237614 DOI: 10.1016/s1470-2045(16)00162-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data from EUROCARE have consistently shown lower survival for adolescents and young adults (AYAs; aged 15-24 years) than for children (0-14 years) for most cancers that affect both groups, and modest survival improvements up to 2000-02. AYAs have longer survival than that of adults for most cancers. We used the latest definition of AYAs (aged 15-39 years) and provided estimates of 5-year relative survival for European AYAs with cancer diagnosed in 2000-07, compared with children and adults (40-69 years) with cancer, and assessed survival improvements over time. METHODS We analysed data from population-based cancer registries of 27 European countries participating in EUROCARE-5. We used the so-called complete method to estimate 5-year, population-weighted relative survival for 19 cancers affecting AYAs and children, and for 27 cancers affecting AYAs and adults. We assessed relative-survival differences between children versus AYAs, and between AYAs versus adults, using the Z test. We used the period approach to estimate 5-year relative survival over time for children and AYAs, and used a generalised linear model to model survival time trends (1999-2007) and to assess the significance of changes over time. FINDINGS We analysed 56 505 cancer diagnoses in children, 312 483 in AYAs, and 3 567 383 in adults. For all cancers combined, survival improved over time for AYAs (from 79% [95% CI 78·1-80·5] in 1999-2002 to 82% [81·1-83·3] in 2005-07; p<0·0001) and children (from 76% [74·7-77·1] to 79% [77·2-79·4]; p<0·0001). Survival improved significantly in children and AYAs for acute lymphoid leukaemia (p<0·0001) and non-Hodgkin lymphoma (p<0·0001 in AYAs and p=0·023 in children). Survival improved significantly in AYAs only for CNS tumours (p=0·0046), astrocytomas (p=0·040), and malignant melanomas (p<0·0001). Survival remained significantly worse in AYAs than in children for eight important cancers: acute lymphoid leukaemias, acute myeloid leukaemias, Hodgkin's lymphomas, non-Hodgkin lymphomas, astrocytomas, Ewing's sarcomas, and rhabdomyosarcomas (p<0·0001 in all cases), and osteosarcomas (p=0·011). INTERPRETATION Notwithstanding the encouraging results for some cancers, and overall, we showed poorer survival in AYAs than in children for the eight important cancers. Recent European initiatives to improve outcomes in AYAs might reduce the survival gap between children and AYAs, but this reduction can only be verified by future population-based studies. FUNDING Italian Ministry of Health, European Commission.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Foschi
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Charles Stiller
- Childhood Cancer Research Group, University of Oxford, Oxford, UK
| | - Emmanuel Desandes
- CHU Nancy, Registre National des Tumeurs Solides de l'Enfant, Vandoeuvre-lès-Nancy, France; Université Paris-Sorbonne, CRESS équipe 7, INSERM UMRS-1153, Paris, France
| | - Milena Maria Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Franco Merletti
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Torino, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Singh R, Shirali R, Chatterjee S, Adhana A, Arora RS. Epidemiology of cancers among adolescents and young adults from a tertiary cancer center in Delhi. Indian J Med Paediatr Oncol 2016; 37:90-4. [PMID: 27168706 PMCID: PMC4854053 DOI: 10.4103/0971-5851.180135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: Although cancer in adolescents and young adults (AYAs) is increasingly an area of focus, there is a paucity of clinical and epidemiological data from developing countries. Our objective was to analyze the geographical distribution, sex ratio, histology, and disease patterns of cancers in AYA. Materials and Methods: All patients aged 15-29 years with the diagnosis of cancer who were registered with two hospitals in New Delhi during a 12-month period from January 2014 to December 2014 were included. Basic demographic information on age, sex, location of stay, and nationality was available. Using cancer site and morphology codes, the cancers were grouped by the Birch classification of AYA cancers. Clinical information on disease and treatment status, was retrospectively studied. Results: There were 287 patients (57.5% male, 85.4% Indian origin) registered with 54 (18.8%), 97 (33.8%), and 136 (47.4%) patients in the 15-19, 20-24, and 25-29 years age groups, respectively. The three most common cancer groups were carcinomas (40.8%), lymphomas (12.9%), and leukemias (10.4%). The three most common sites in carcinomas were gastrointestinal tract (GIT), genitourinary tract, and breast. The most prevalent cancers in younger AYA (15-19 years) were leukemias, lymphomas, central nervous system neoplasms, and in contrast, older AYA (25-29 years) suffered mainly from GIT Carcinomas, lymphomas. The leading cancers were breast and GIT carcinomas in females and lymphomas and GIT carcinomas in males. Conclusion: The occurrence of cancer in AYA in India has been described. The distribution differs from the only previous report from India as well as the US Surveillance Epidemiology and End Results database, which can be attributed to a referral bias along with the factual difference in cancer etiology and genetics.
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Affiliation(s)
- Randeep Singh
- Consultant Medical Oncologist, Department of Medical Oncology, Max Cancer Centre, Delhi, India
| | - Rashmi Shirali
- Consultant in Cancer Research, Department of Medical Oncology, Max Cancer Centre, Delhi, India
| | - Sonali Chatterjee
- Registrar, Department of Medical Oncology, Max Cancer Centre, Delhi, India
| | - Arun Adhana
- Cancer Registry Technician, Department of Medical Oncology, Max Cancer Centre, Delhi, India
| | - Ramandeep Singh Arora
- Consultant Pediatric Oncologist, Department of Medical Oncology, Max Cancer Centre, Delhi, India
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Abstract
The spectrum of cancers commonly found in adolescents and young adults (AYAs) differs from those in children and adults; therefore, the childhood classification is not appropriate for this population. Here we used a newly proposed classification system to reclassify cases of AYAs from Brazilian population-based cancer registries (PBCRs) in 5 geographic regions of Brazil. We aimed to describe the cancer incidence rates within this age group according to PBCR. Using the world population, incidence rates per million were analyzed in each diagnostic subgroup according to sex and age at diagnosis (15 to 19 y, 20 to 24 y, and 25 to 29 y). The median incidence rate was 232.31 per million for females and 218.07 per million for males. Incidence increased with age, with the highest rate observed for 25- to 29-year-olds in both sexes. Carcinomas, lymphomas, and skin tumors were most frequent among AYAs. High incidence rates of cervix-uterus carcinoma were observed in most PBCRs. AYAs present epidemiological characteristics that differ from those of children, reinforcing the need for a new classification. This study describes, for the first time, the cancer incidence rate in AYAs in Brazil, and we believe that our findings represent the Brazilian profile.
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