Journal of adolescent and young adult oncology最新文献

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.

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.