Journal of adolescent and young adult oncology最新文献

Purpose: In hormone therapy for premenopausal breast cancer (BC), gonadotropin-releasing hormone (GnRH) agonist (GnRHa) formulations, especially long-acting formulations, are often used in combination with tamoxifen (TAM). On the other hand, in recent years, endocrine therapy is increasingly interrupted to achieve pregnancy. Here, we examined ovarian function and the timing of resumption of menstruation after the interruption of GnRHa therapy. Methods: Fertility preservation patients with BC who visited our hospital between January 2010 and August 2023 and who interrupted endocrine therapy with a GnRHa formulation were included. Information on 22 cases (24 cycles), including two interruptions due to the desire for a second child, was collected from medical records and examined retrospectively. Results: Three cases started assisted reproductive technology treatments before menstruation resumed and were excluded from the analysis. Menstruation resumed at approximately 7, 9, and 12 months from the last dose of the 1-, 3-, and 6-month GnRHa formulations, respectively. The long delay of menstruation resumption was presumably caused by the use of (1) the 3-month formulation in the 6 months before the last GnRHa dose, (2) the 6-month formulation in the 12 months before the last dose, and (3) TAM when menstruation resumed. Conclusions: In BC patients who may seek pregnancy after interrupting endocrine therapy, it may be easier to estimate the timing of resumption of menstruation if the use of long-term GnRHa depot formulations is avoided for >6 months before the interruption. BC endocrine therapy should be optimized to achieve pregnancy and childbirth as soon as possible during its interruption.

Purpose: Adolescents and young adults (AYAs; 15-39 years) with sarcoma undergo intensive therapies during a vulnerable time in their lives. We aimed to characterize the unmet needs of AYAs with sarcoma to inform strategies that improve outcomes. Methods: We used purposive sampling to conduct semistructured focus groups of AYAs with sarcoma treated primarily at Dana-Farber Cancer Institute. Focus groups were conducted via Zoom by trained moderators and focused on experiences with treatment, decision-making, care communication, supportive care services, and the effects of cancer on daily life. Focus groups were audio recorded, transcribed, and thematically analyzed via a team-based approach. Results: We conducted four focus groups with 20 participants (16-34 years) adolescents, emerging adults, young adults, and those with recurrent/metastatic disease. Participants confirmed that sarcoma and its treatment affected their physical, emotional, social, and economic health. We identified three key overarching themes: (1) Disruption to agency and mobility negatively impacted well-being and social relations; (2) The transition from "active treatment" to "surveillance" was fraught as it often magnified challenges of "returning to normal" and loss of autonomy; and (3) Additional supports and services may help address identified unmet needs and gaps in care. Participants expressed a desire for support services to be introduced earlier to help facilitate independence. Conclusion: AYAs with sarcoma experience loss of agency, mobility, and impaired well-being due to their diagnoses and treatments. They desire early introduction of supportive services, and care teams can proactively address these challenges by connecting patients with targeted services, resources, tools, and community.

Purpose: Approximately half of male childhood cancer survivors experience treatment-related fertility impairment. Regrets about missed sperm banking opportunities have been reported, yet few decision tools for male adolescents with cancer exist. This study aims to report the development, testing, and adaptation of the Family-centered Adolescent Sperm banking values clarification Tool (FAST) using an iterative, user-centered design with male adolescents with cancer and their caregivers and to obtain feedback from clinicians and community partners. Methods: Males (12-25 years, diagnosed with cancer in the past year, received a routine fertility consult where sperm banking was offered) and caregivers completed the FAST on a screen-recorded device, a semi-structured interview, the System Usability Scale (SUS), and a sociodemographic questionnaire. Feedback informed FAST adaptations and was documented using the Framework for Reporting Adaptations and Modifications-Expanded. Descriptive statistics and thematic analysis characterized FAST completion information. Results: Ten families (16 caregivers, 9 adolescents) enrolled. Themes included: ease of navigation, perceived usefulness of the FAST, and perspectives on tool adaptations. Forty-three FAST adaptations were made in response to participant feedback. Median FAST completion time was 5 minutes and 37 seconds. The mean FAST SUS score was high at 84.60 (minimum = 57.50, maximum = 100, standard deviation = 11.08). Conclusions: Applying an iterative, user-centered approach, the FAST was developed, usability-tested, and adapted to a web-based format that families found easy to navigate and useful. Web-based tools, such as the FAST, could improve the sperm banking decision-making process for adolescent males and their caregivers by addressing unmet needs and ultimately improving satisfaction with fertility counseling outcomes.

Background and Aim: Adolescent and young adult (AYA) patients who require pancreatectomy are rare. There are few reports concerning the characteristics of AYA patients undergoing pancreatectomy for malignant tumors. This study aimed to clarify the characteristics and outcomes of AYA patients who had undergone pancreatectomy. Methods: AYA patients (age 15-35 years) who underwent pancreatectomy at our institution between 1995 and 2018 were included in this study. The diagnosis, operative procedure, complications, mortality, and survival were retrospectively analyzed. Results: Forty-seven patients underwent pancreatectomy (median age 29 years; range, 16-35 years). The diagnoses were solid-pseudopapillary neoplasm (SPN; n = 21 [44.6%]), neuroendocrine neoplasm (NEN; n = 12 [25.5%]), adenocarcinoma (n = 5 [10.6%]), and others (n = 9 [19.1%]). The surgical procedures included pancreatoduodenectomy (PD; n = 17 [36.1%]), distal pancreatectomy (DP; n = 18 [38.2%]), middle pancreatectomy (n = 8 [17.0%]), and tumor enucleation (n = 4 [8.5%]). The most common postoperative complication was pancreatic fistula (POPF) (n = 29 [61.7%]). Hemorrhage was noted in one case, but the surgical mortality rate was 0%. Long-term complications included four cases of pancreatitis, three cases of diabetes, two cases of bowel obstruction, and one case of cholangitis. The 5-year recurrence-free-survival (RFS) and overall-survival (OS) rates in patients with SPN/NEN/others were 91.8% and 97.5%, respectively. In contrast, the 5-year RFS and OS rates in patients with adenocarcinoma were 53.3% and 80.0%, respectively. Conclusion: Most AYA patients who underwent pancreatectomy had low-grade malignancies and showed a favorable survival. Although POPF and pancreatitis frequently occur, radical surgery-even major pancreatectomy such as PD and DP-is feasible and effective in AYA patients with malignant tumors.