Journal of adolescent and young adult oncology最新文献

Adolescents and young adults (AYA; ages 15-39) with acute leukemia have significant unmet supportive care needs. This pilot study integrated same-day palliative care (PC) into an AYA leukemia clinic, measuring symptom burden (SB) with validated symptom assessment tools at baseline, 3, and 6 months. Among 31 patients, moderate-severe symptoms included tiredness, anxiety, and poor appetite. AYAs experienced high SB and psychological distress, regardless of care phase or sociodemographics. With PC integration, tiredness and depression improved significantly; no symptoms worsened. Half of the PC visits led to management changes. Early integration of symptom-focused PC was feasible, value-adding, and well-received by patients.

Purpose: Adolescent and young adult oncology patients represent a unique group with complex needs, yet data on palliative care utilization remain scarce in the Asian population. The definition of this group remains heterogeneous across organizations, and it is unclear whether extending the age range beyond conventional cutoffs affects observed patterns of care. We conducted a retrospective cohort study to describe palliative care utilization and end-of-life outcomes among oncology patients aged 16-45 years at a tertiary cancer center in Singapore. Methods: Oncology patients aged 16-45 referred to the palliative team from 2011 to 2021 were identified using institutional databases. Chi-square tests and sensitivity analysis were used to compare outcomes across age groups. The timing of last treatment relative to palliative referral was described. Multivariable logistic regression was performed to identify predictors of aggressive care. Results: Median age was 37 years; 58.8% were female; 83.6% of patients were deceased at the time of study. There was a trend toward earlier referrals in recent years, including during the COVID-19 pandemic. Outcomes including cause of death, place of death, rates of early/late referral, and aggressive care did not differ significantly across age groups. Timing of referral was the key independent factor associated with poor end-of-life outcomes including aggressive treatment. Conclusion: Referral patterns and end-of-life care intensity are consistent across ages through 45 years. Late palliative referrals were associated with higher usage of aggressive treatment and death in hospital. Findings support integrated, timely access to palliative care in this group and validate flexibility in the definition of age ranges.

Purpose: Adolescents and young adults (AYAs) with brain tumors are at an increased risk of developing psychiatric disorders. We aimed to investigate the incidence and characteristics of psychiatric disorders in AYA patients with brain tumors. Methods: Using the Korean Classification of Diseases, we identified a cohort of AYA patients (aged 15-34 years) diagnosed with malignant brain neoplasms (C71) between 2003 and 2016 from the Korean National Health Insurance Claims Database. The analysis included 7052 patients. Results: The 10-year cumulative incidence rate of psychiatric disorders was 21.5%. The most common psychiatric disorders were neurotic, stress-related, and somatoform disorders (11.4%), followed by mood (affective) disorders (9.4%). Factors associated with a higher incidence of psychiatric disorders included female sex (hazard ratio [HR] 1.16, 95% confidence interval [CI]: 1.05-1.28, p = 0.005), history of seizures (HR: 1.47, 95% CI: 1.31-1.66, p < 0.001), and brain tumor diagnosis during the latter part of the study period (HR: 1.14, 95% CI: 1.03-1.27, p = 0.010). Psychiatric hospital admissions were most frequent among patients with schizophrenia, schizotypal disorders, and delusional disorders (n = 5). The most common psychiatric disorders requiring psychotherapy were neurotic, stress-related, and somatoform (n = 580) and mood (n = 526) disorders. Conclusion: A significant number of AYA patients with brain tumors develop psychiatric disorders after diagnosis, and most require treatment. Early detection through screening programs and personalized psychological support during and after cancer treatment may improve the mental health and quality of life of AYA patients with brain tumors.

Purpose: Survivors of adolescent and young adult (AYA) cervical cancer who undergo radiation therapy are at risk of significant long-term health sequelae. We seek to evaluate long-term toxicities and their impacts on survivors. Methods: Patients treated for cervical cancer with radiation therapy between ages 18 and 39 in the years 2000-2010 in British Columbia were eligible. One hundred eligible patients were identified and mailed a package containing a questionnaire devised by a multidisciplinary team and validated patient-reported quality of life surveys for patients with cervical cancer, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-30 and CX-24. Results: A total of 22 responses were received. The average time since treatment was 17.0 years (range 12-22). Fertility preservation prior to treatment was discussed with 41% of respondents and offered to 36%. A single respondent had a child after treatment through adoption. The mean EORTC Quality of Life score was rated as 63.9. Mean functional status scores include 84.4, 83.3, 67.1, 70.6, and 77 for physical, role, emotional, cognitive, and social functioning, respectively. Elevated symptom scores include sexual/vaginal functioning (53.5), sexual worry (55.6), diarrhea (38.1), body image concerns (41.7), peripheral neuropathy (39.7), and menopausal symptoms (38.1). Many patients (32%) indicated sexual and vaginal health symptoms impacting quality of life. Other common symptoms include permanent bowel changes (27%), bladder changes (27%), mood disorders (27%), and lymphedema (18%). Multiple respondents (18%) commented on regrets for not pursuing fertility preservation. Conclusions: Long-term survivors of AYA cervix cancer have significant concerns, mood disorders, premature menopausal symptoms, and fertility issues. Respondents indicated a desire for improved fertility counseling.

Objective: The aim of this study was to determine the incidence of the self-use of plants in cancer patients and its impact on overall survival (OS). Methods: This was a prospective study including young adult patients collected between January 15, 2018 and January 15, 2019 in the department of medical oncology at the Habib Bourguiba University Hospital. All patients were questioned about the concept of taking herbs. We compared OS among those who received plants versus the nonusers. Results: A total of 223 patients were included. The average age was 35 ± 4 years. Ninety-seven patients had taken plants. Sixty patients had consumed alenda (61.8%), and 36 patients had received graviola (37.1%). Ten patients have had diarrhea (10.3%), 10 cytolysis (10.3%), 11 cholestasis (11.3%), 15 thrombocytosis (15.4%), 17 leukocytosis (17.5%), and 13 anemia (13.4%). OS at 5 years was 67.1%. It was lower in patients consuming the plants (54% vs. 83%, p = 0.023). Conclusion: Factors associated with a decrease in the 5-year OS were metastatic stage and plant consumption.

Purpose: This study aims to explore the impact of cancer on romantic relationships and marriage from the perspective of partners of adolescent and young adult (AYA) cancer survivors. Methods: Semistructured interviews were conducted with 10 partners, of any gender and cancer type, who entered into a relationship or decided to marry after the AYA's cancer diagnosis. Results: Three key themes emerged regarding the impact of cancer on romantic relationships and marriage: no change or impact, positive impact, and anxiety. Negative impacts were rarely reported, although some participants suggested that, had the illness been more severe or active at the time they met, they might have hesitated to commit or marry. Positive impact included respect for cancer survivors and a sense of fulfillment from having overcome the disease together. Conclusion: Partners of AYAs generally accepted the disclosure of the survivor's cancer history without distress and demonstrated supportive attitudes. There were few negative effects on relationships or marriage, and no differences in impact were found based on cancer type. Cultural differences were noted in attitudes toward having children, in contrast to findings from studies conducted in Western countries.

Purpose: Adolescent and young adult (AYA) survivors of acute lymphoblastic or myeloid leukemia diagnosed between the ages of 15 and 39 years are at risk for adverse late health effects following cancer treatment and require ongoing survivorship care. This study aims to understand the landscape of transitioning AYAs with leukemia from active treatment to survivorship care. Methods: A cross-sectional, anonymous online survey was sent out via listserv/email. Descriptive analyses were used to identify the proportion of providers whose institutions have AYA and/or survivorship programs, current practices in transitioning care, perspective on barriers and facilitators to transition, and preferred models of survivorship care. Differences by provider (i.e., adult medical oncologist vs. pediatric) were analyzed using chi-square or analysis of variance (ANOVA) analyses. Results: A total of 75 provider responses were analyzed; 51.4% of providers reported their institutions had an AYA program and over 80% had a survivorship program. Providers preferred the primary oncology team or survivorship specialist to address most survivorship care needs, except for the treatment of other comorbid conditions (primary care provider [PCP] preferred). Disease-related risks, lack of a PCP, and insurance concerns were commonly endorsed barriers to transition of care. Medical oncologists were more likely than pediatric providers to transition surveillance of new malignancies to PCPs. Conclusions: Providers preferred survivorship specialists to oversee AYA survivorship care, yet several barriers and concerns remain to implement the transition. Results indicate variability in transition care practices and preferences, particularly between medical and pediatric oncologists. Future work is needed to optimize transition practices to improve care for AYA survivors.

Purpose: To investigate cardiorespiratory fitness (CRF), body composition, health behaviors, and health-related quality of life (HRQoL) in adolescent and young adult cancer survivors (AYA-CS) compared with age-matched counterparts without a cancer diagnosis. Methods: This cross-sectional study recruited participants aged 15-25 years at the time of their cancer diagnosis and ≥ 5 years post-treatment. Participants completed cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, food diaries, physical activity (PA), fatigue, and HRQoL questionnaires. Results: We recruited 22 participants aged 27.9 (standard deviation [SD] 3.3) years (54.5% female) and 7.2 (SD 2.2) years post-treatment. AYA-CS had lower CRF compared with age-matched norms (female 27.1 vs. 39.1 mL/kg/min, p ≤ 0.0001; male: 39.7 vs. 45.6 mL/kg/min, p = 0.04). Bone mineral density Z-scores were all within normal ranges; however, male AYA-CS had higher body fat percentage (male: 27.1% vs. 21.2%, p = 0.01) and a trend toward higher body fat percentage in female AYA-CS (32.2% vs. 29.8%, p = 03). AYA-CS had lower HRQoL, with no difference observed with fatigue. A higher proportion of AYA-CS met recommendations for weekly PA (36.4% vs. 27.3%, p = 0.34) and daily servings of fruit and vegetables (13.6% vs. 3.9%, p = 0.02) compared with normative data, demonstrating better health behaviors. A higher proportion of AYA-CS reported one or more chronic diseases compared with Australian normative data (63.7% vs. 41.5%, p = 0.04). Conclusions: AYA-CS exhibit significantly lower CRF and unfavorable body composition to age-matched counterparts. These health outcomes may adversely impact everyday functional performance and increase the risk of multimorbidity development. Interventions are needed to address these issues to improve health outcomes in AYA-CS.

Purpose: Cancer organizations recommend cost-of-care (CoC) information be provided to patients with cancer by their care teams. Little is known about the CoC conversation experiences and preferences of adolescents and young adults (AYAs) with cancer. Methods: Eligible participants were 18-39 years old, diagnosed with cancer, and insured. Recruitment occurred at two cancer centers in Utah from October 2019 to March 2020. Data were collected via survey and semistructured telephone interviews, which were recorded and transcribed. Interview questions pertained to willingness, perceived usefulness, and past experiences with CoC conversations with their cancer care team. Interviews were analyzed by applying two rounds of thematic content analysis. Summary statistics were calculated for demographics, health insurance literacy, and financial toxicity. Results: Among 24 participants, half were aged 18-25 and half were aged 26-39 at interview and survey, with many currently receiving treatment (62.5%). Four qualitative themes emerged concerning CoC conversations (1) past experiences, (2) willingness, (3) usefulness, and (4) preferred provider. In interviews, most AYAs shared interest in discussing CoC, but previous CoC conversations were infrequent. Most AYAs who had previous CoC conversation experiences brought up the topic themselves. Interview data revealed that preferred individuals to lead CoC conversations were often social workers (25.0%), nurses (20.8%), or oncologists (20.8%), while others wanted any provider knowledgeable in financial matters (20.8%). Conclusions: AYA patients are willing to have CoC conversations; however, they infrequently occur. Future work may include interventions that guide clinicians in initiating in-depth CoC discussions with AYAs.