Journal of adolescent and young adult oncology最新文献

Purpose: This study examines cancer screening rates and the usual source of care among Hispanic survivors of adolescent and young adult (AYA, aged 15-39) cancer, a group at increased risk for poor health outcomes, including secondary cancers.

Methods: National Health Interview Survey data were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Breast, cervical, and colorectal screening (ever screened and up-to-date according to the U.S. Preventive Services Task Force recommendations) as well as reporting a usual source of care were compared among survivors and controls eligible for screening using multivariable logistic regressions.

Results: Hispanic survivors were significantly more likely than Hispanic controls to report up-to-date cervical (43.8% vs. 25.5%, p < 0.001) and colorectal (43.1% vs. 21.8%, p = 0.002) cancer screenings. Eligible female survivors were also significantly more likely than controls to report ever having been screened for breast (86.9% vs. 60.6%, p < 0.001) and cervical (43.3% vs. 17.2%, p < 0.001) cancers. Additionally, survivors were significantly more likely than controls to report a usual source of care (74.4% vs. 49.9%, p < 0.001).

Conclusion: Although Hispanic survivors of AYA cancers were more likely than Hispanic individuals without a history of cancer to report up-to-date cancer screening, screening rates among both groups remain low. Notably, approximately one-quarter of survivors reported lacking a usual source of care, indicating potential gaps in preventive health care access. The findings highlight the need for targeted interventions to improve cancer screening uptake among Hispanic survivors of AYA cancer.

Purpose: Pain management remains challenging for adolescent and young adult (AYA) cancer patients. Acupuncture and massage have been recommended for cancer-related pain management, but no prospective trials have been conducted in AYA patients. We explored the effects of acupuncture and massage on pain in AYAs.

Methods: This subgroup analysis focused on AYA patients (aged 18-39 years) enrolled in a randomized controlled trial comparing acupuncture and massage for pain management in advanced cancer. Interventions were delivered weekly for 10 weeks, followed by monthly booster treatments through week 26. The primary outcome was the worst pain score from the Brief Pain Inventory, analyzed using a linear mixed-effects model.

Results: Thirty participants met eligibility criteria (13 acupuncture; 17 massage), with a mean age of 31.1 years (standard deviation, 5.8); 57% were female; 67% were White; and 53% had solid tumors. Both groups experienced reduced pain over time. Relative to baseline, patients receiving acupuncture had a mean change of -1.26 points (95% confidence interval [CI], -2.54 to 0.01) at 10 weeks and a mean change of -1.46 points (95% CI, -2.78 to -0.14) at 26 weeks. Patients receiving massage experienced a mean change of -2.81 points (95% CI, -3.92 to -1.70) at week 10 and a mean change of -3.79 points (95% CI, -4.85 to -2.73) at week 26.

Conclusion: AYA patients with advanced cancer who received either acupuncture or massage experienced clinically meaningful and sustained reductions in pain. These findings provide a promising foundation for future trials aimed at evaluating integrative pain management strategies in AYAs.

Purpose: Adolescents and young adults (AYAs) experience higher burdens of negative psychological outcomes (e.g., depression, anxiety, and stress) of cancer compared to older survivors and caregivers. We elicited feedback about the adaptation of two randomized controlled trials (RCTs), one using a symptom management and survivorship handbook (SMSH) and another using telephone-based interpersonal counseling, for AYA cancer survivors and caregivers of AYAs.

Methods: Following the parent RCT, we conducted a follow-up study using semi-structured telephone interviews to elicit feedback from AYAs (ages 18-39 years at diagnosis) and adult caregivers of AYAs (aged 18+). Participants were asked to share satisfaction with the (1) content, (2) delivery, and (3) general experiences in the study. Interviews were recorded, transcribed, and quality checked. We categorized qualitative feedback through interpretive description.

Results: There were N = 18 participants 10 women and 8 men; 8 cancer survivors and 10 caregivers. The interviews were 5-20 minutes (average = 10.5 minutes). Participants enjoyed the content and found the information helpful. Participants preferred digital materials for accessing information about cancer symptom management and treatment. Some participants continue to use the information from the SMSH after their participation.

Conclusions: AYA cancer survivors and caregivers of AYAs were largely satisfied with the content of the intervention materials. Minor suggestions arose to modify the intervention materials to be more suitable through including digital materials and social connections.

The UNI-AJA project is a French epidemiological study analyzing cancer care pathways and outcomes in adolescents and young adults (AYAs, 15-29 years) from 2009 to 2022. Using data from 10 health institutions and national databases, it will examine treatment types, delays, second cancers, long-term effects, and causes of death. The study will employ deterministic linkage for comprehensive patient tracking. It will assess care evolution, the impact of AYA-specific structures, and treatment consequences. Findings will support improved cancer management and policy decisions in France. This project may lay the foundation for a national clinico-epidemiological database for AYAs with cancer.

Purpose: Treatment advances have led to a rapidly growing population of adolescent and young adult (AYA, ages 15-29) survivors of childhood cancer. Despite cure, AYA are physically and psychologically vulnerable due to treatment toxicity, leading 70% to develop second cancers or chronic, often life-threatening, late effects. Self-management is critical for survivorship and includes lifelong follow-up care, health promotion, disease surveillance, and management of late effects. Survivorship care plans (SCPs) are documents to inform survivors and providers of recommendations for management of survivor health and to improve communication among providers. With limited SCP research to date, there are calls for rigorous research to understand SCP implementation.

Methods: Qualitative semistructured interviews were conducted to assess perceptions about SCPs, including barriers and facilitators of SCP implementation among 12 purposefully sampled AYAs who received an SCP in the extant trial, 8 caregivers of AYA, 10 oncology providers, and 8 pediatric primary care providers.

Results: Overall, SCPs were viewed as generally positive by AYA and caregivers, with caveats about ways to improve them or use them. Oncology providers also generally had a positive view of the SCP, but primary care practitioners found them to be less targeted to their specific needs.

Conclusion: Our results helped to clarify critical aspects of implementation that need to be addressed if SCPs are to be successfully implemented into survivorship care for AYA, especially as they transition to adult-oriented health care.

Purpose: Anti-Mullerian hormone (AMH) is a surrogate measure to assess ovarian reserve in childhood cancer survivors, but consensus is lacking on when to obtain and how to use AMH data.

Methods: Pediatric and adolescent committee (PAC) members of the Oncofertility Consortium were invited by email to complete a survey regarding ovarian reserve surveillance and their use of AMH. Responses were collected through REDCap, and results were stratified by specialty: pediatric oncology and endocrinology (PED) or adult/pediatric gynecology and reproductive endocrinology (GYN). Descriptive statistics and Fisher's exact tests were used for analysis using SAS v9.4.

Results: Surveys were completed by 48 of 123 eligible PAC members (28 PED, 19 GYN, response rate 39%). The majority (83.3%) reported using AMH as a measure of ovarian reserve, with the earliest timepoint to begin AMH surveillance to be 12-23 months from therapy completion (63%). While most respondents felt the benefits of testing outweighed the limitations (78.7%), commonly reported limitations included variability of results (60.4%) and lack of standardization in use of AMH (52.1%). Differences between PED and GYN respondents included how AMH was used among their clinical practice and the timing of laboratory evaluation.

Conclusions: Most respondents indicated they used AMH; however, practices in its application varied depending on specialty backgrounds. Evidence-based clinical practice guidelines would improve the standardization of surveillance and counseling and prevent missed opportunities for fertility preservation in survivorship.

This study examined sperm banking (SB) practices and barriers for post-pubertal males with high-risk acute lymphoblastic leukemia (ALL) prior to chemotherapy. A cross-sectional survey of 2345 Children's Oncology Group oncologists across the U.S., Canada, Australia, and New Zealand yielded 572 responses. While 78% offer SB, common barriers include timing (70%) and patient health (44%). Most institutions offering SB have a dedicated oncofertility team (57%), and 86% are medium- or large-sized, suggesting greater resource availability. These results extend prior research by identifying actionable barriers and informing targeted interventions to improve access to FP for post-pubertal males with ALL.

An increasing number of cancer predisposition syndromes (CPSs) have been associated with childhood cancer in light of advent advances in genomic medicine. While children and adolescents with CPSs present with compounded medical and psychosocial sequalae across the developmental trajectory, little is known about how adaptive psychosocial outcomes are conceptualized and promoted. Exploring adaptive and modifiable targets in psychological care may potentially promote coping among patients with CPSs and their families. The study undertakes a scoping review to describe, synthesize, characterize, and identify gaps in the literature on adaptive psychosocial outcomes among young people with CPSs and their caregivers. Adhering to PRISMA Extension guidelines and checklist, a systematic search in four databases was most recently conducted in February 2024: (PubMed, EMBASE, CINAHL, and PsycINFO). A total of 642 titles were screened and 36 articles were reviewed at the full-text level. Of those, five met the study inclusion criteria. The majority of articles were descriptive and centered around caregivers of at-risk patients with CPSs. The scoping review describes what is known about adaptive psychosocial outcomes associated with pediatric CPS and underscores the substantial gap in existing literature. Several important findings were identified across studies: significance of undergoing genetic testing, perceived surveillance benefits, positive psychological outcomes, intra-family communication, young people and caregiver psychosocial support. Future research is needed to investigate adaptive psychosocial outcomes associated with CPSs and delineate potential coping mechanisms. Findings may inform the development and dissemination of evidence-based psychological approaches designed to promote coping with pediatric CPSs.

Purpose: This study evaluated the program delivery of a part of the age-specific intervention Young Adult Taking Action (YATAC), a rehabilitation program for young adult cancer survivors, focusing on dose, adherence, fidelity and adaptation. It also explored changes in health-related quality of life, fatigue, depression, anxiety, and loneliness.

Methods: A one-armed feasibility study with 19 young adult cancer survivors (aged 18-39) involved in a multicomponent rehabilitation program a 5-day residential stay, a 10-week home-based period, and a 2-day follow-up. Program delivery data were collected during the stays, and patient-reported outcomes were assessed at baseline and 10 weeks. Changes were analyzed using the Wilcoxon signed-rank test, and responder analysis assessed minimal clinically relevant changes.

Results: All sessions were delivered, with 100% of participants completing the five-day and a two-day stay. Adherence and fidelity were both 83%, though 30% of sessions reported time constraints. Significant improvements were observed in cognitive functioning (p = 0.0046), fatigue (p = 0.0066), and anxiety (p = 0.0146). More participants showed minimal clinically relevant improvements in cognitive functioning (63%) than deteriorations. Fatigue was the only outcome with no reported clinically relevant deterioration.

Conclusion: The tested part of the YATAC program demonstrated feasibility with high adherence and fidelity. Some adjustments to session duration and structure are needed. The program showed potential to improve cognitive function, fatigue, and anxiety, though findings should be interpreted cautiously due to the small sample size and one-armed design.

Purpose: Young adult (YA) cancer survivors aged 18-39 years face increased chronic disease risk. Although YA survivors prioritize health, structural barriers may limit their ability to maintain healthy lifestyles, particularly in culturally and geographically diverse regions. This mixed-methods study explored health priorities, social determinants of health (SDoH)-related barriers and facilitators to maintaining a healthy lifestyle, and intervention preferences for YA cancer survivors in New Mexico (NM) to inform future interventions.

Methods: Descriptive statistics and thematic analysis were conducted on surveys and semistructured interviews with 17 YA cancer survivors and 11 YA cancer care providers in NM. Surveys assessed demographics and, for survivors, SDoH, and intervention preferences.

Results: Social isolation was the most prevalent adverse SDoH, affecting 47% of YAs. YAs expressed interest in diet/physical activity-related programs (82%) and were flexible about group/one-on-one (59%) and in-person/online (71%) program formats. YA themes included: physical and mental health are priorities post-treatment; multilevel barriers and facilitators shape health behaviors; there is a lack of YA-specific resources; community building is key for peer support; support strategies to address psychosocial, behavioral, and health care navigation concerns are needed. Provider themes included: YAs have specific care needs during the survivorship transition to long-term wellness; collaborative, innovative organizational solutions are critical, peer and community support is effective, and integrating psychosocial and culturally informed care enhances outcomes; there is a need for empowering support tailored to the needs of YA survivors in NM.

Conclusion: Physical, mental, and social health are priorities for YA cancer survivors post-treatment. Findings highlight the need for flexible, community-informed interventions that support holistic health and long-term survivorship.