Journal of adolescent and young adult oncology最新文献

Purpose: Childhood acute lymphoblastic leukemia (ALL) is associated with executive dysfunction in long-term survivorship. This is evidenced by subjective and objective measures of executive functions (EFs). However, the two measures do not always align, and the EF discrepancy in this population is understudied. This cross-sectional study aimed to examine the association between global measures of subjective and objective EF in young adult (YA) survivors of childhood ALL. Second, we aimed to explore how psychological distress, fatigue, self-efficacy, and estimated IQ relate to the discrepancy between these measures. Methods: A total of 53 subjects (age 18-34) participated in a clinical trial baseline assessment (clinicaltrials.gov NCT04541056). The Behavior Rating Inventory of Executive Function for Adults assessed subjective EFs. Results from six neurocognitive tests were combined to represent objective EFs. Discrepancy scores were calculated by subtracting the objective EF composite score from the subjective EF score. Spearman's correlations and simple and multiple linear regression analyses were performed to explore associations and predictors for the global EF discrepancy. Results: Subjective and objective measures of EF were moderately correlated (r_s = 0.407). The regression analyses showed that psychological distress (R² = 0.44), fatigue (R² = 0.29), and self-efficacy (R² = 0.24) significantly predicted the global EF discrepancy (p < .001). Only psychological distress explained unique variation (B = -0.46). Conclusion: Neurocognitive tests and self-reports offer valuable insights into EF assessment for YA survivors. Psychological distress emerged as the most central contributor to the overall EF discrepancy. Consequently, screening for anxiety and depression alongside subjective EF complaints will be of significance.

Purpose: The population of childhood cancer survivors in low- and middle-income countries is set to increase due to diagnosis and treatment advancements. However, cancer is still associated with stigma that may hinder societal re-entry. This study explores the social reintegration and stigmatization of Kenyan childhood cancer survivors to develop targeted interventions for follow-up care. Methods: Adult survivors of childhood cancers who completed treatment at the largest referral hospital in Western Kenya were interviewed using semi-structured questionnaires between 2021 and 2022. Stigma was assessed using the Social Impact Scale. Results: Twenty-six survivors (median age 20 years) were interviewed, with 16 (62%) being males. All survivors missed classes during treatment, and 16 (62%) had to repeat school grades after treatment completion. Many (13; 50%) reported negative feelings about the situation at school. Six (23%) were excluded from school activities and four were bullied (15%). Most 25 (96%) could not openly speak about cancer to all community members. Reasons for lacking social support, avoidance, and discrimination were cancer is a curse, contagious, or inheritable. Nine (35%) felt that their marital prospects were negatively affected by their cancer history. Stigma was higher for survivors who received a negative response after cancer disclosure (p = 0.001) and survivors with negative perspectives on their marital prospects (p = 0.002). Survivors recommended community and school education, peer support groups, and counseling. Conclusion: Childhood cancer survivors in Kenya face difficulties with social reintegration and stigmatization. Outreach campaigns focusing on education at schools and communities should be implemented. Counseling and support groups may facilitate re-entry into society.

The current study identified the fertility-related needs of young adult (YA; ages 19-39) survivors. Participants (n = 94) completed the Adolescent and Young Adult Survivorship Psycho-Oncology Screening Tool-a screening tool developed to assess cancer-related concerns of YAs in survivorship. Approximately one-third of survivors endorsed fertility-related concerns. Frequency of fertility-related concerns was endorsed in descending order: "not knowing fertility status/options," "cost of fertility treatment," "discussing fertility with others," and "grief over fertility." Relationship between fertility concerns and other commonly reported survivorship concerns was identified. Findings highlight a gap in care for fertility-related needs in post-treatment survivorship care for YAs.

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.

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.

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.

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: 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.

The adolescent and young adult (AYA) ages are a time when individuals are susceptible to risky behaviors, including binge drinking, tobacco, marijuana, and illicit drug use. AYAs are at an increased risk for developing chronic health problems compared with their healthy peers, and substance use can pose additional risks. The purpose of this review is to compare substance use in AYAs with their healthy peers and identify contributing factors. A literature search was conducted of PubMed, Scopus, and OVID databases using keywords substance*, adolescent*, adolescence*, teens*, teenager*, young adult*, pediatric*, childhood*, cancer*, and oncology*. The initial search yielded 148 articles. Inclusion criteria specified English language and articles from January 1, 2013, to December 31, 2023. Studies were excluded if they did not include participants aged <18 years and without a noncancer comparison group. Five relevant articles were included after review and appraisal. Substance use was examined by substance use type and contributing factors, including caregiver-AYA relations, age, and depression/coping. Findings were mixed for substance use, including tobacco and alcohol use. Findings indicate no consistent pattern-substance use was both more and less common in AYAs than in their noncancer peers, or substance use did not differ between AYAs and their noncancer peers. With mixed results, each study identified some level of substance use in AYAs. Given this knowledge, when treating AYAs, providers should be diligent about screening for substance use during each visit. AYAs should be educated about the risk of substance use, especially as a vulnerable, at-risk population.

Purpose: The early detection of breast cancer in women under the age of 40 has posed significant challenges. This can be attributed in part to the limited research conducted on the breast cancer in this age group, particularly with regards to large sample sizes. We aimed to address this gap by analyzing and comparing the ultrasound imaging and pathological characteristics of breast cancer in women aged under 40 and those aged 40 and above. Methods: A retrospective assessment was conducted to examine the ultrasound imaging and clinicopathologic characteristics of 555 women with surgically confirmed breast cancers. The patient cohort consisted of 160 individuals below the age of 40 and 395 individuals aged 40 years and above. Results: Our study identified the breast cancer in patients under 40 years was more likely to show regular shape (p = 0.043) compared with tumors in patients who were 40 years and over. Furthermore, in young female patients (<40 years), irregular shape was correlated with the HER2-enriched type (p = 0.02), circumscribed margin (p = 0.001), and a lack of calcifications (p = 0.02) were associated with the triple-negative type. In another group (≥40 years), only a lack of calcifications (p = 0.003) were associated with the triple-negative type. Conclusion: Breast cancer in women under the age of 40 exhibits distinct ultrasonographic characteristics patterns that vary across different immunophenotypes, which may provide certain predictive information for physicians.