Journal of adolescent and young adult oncology最新文献

Over a half million children are living with cancer in the United States. Social media platforms offer unique opportunities for cancer communication by public health organizations as well as health care providers, scientists, patients, and caregivers. Given the dearth of research on childhood cancer communication, the present study aimed to examine the nature of tweets on the social media platform X (formerly Twitter) that used the hashtag #childhoodcancer, the types of these tweets that attracted the most retweets, the types of users tweeting about childhood cancer (e.g., individuals, health care professionals), and the nature of tweets made by the different types of users. We performed a content analysis of tweets we captured on X via NCapture in October and December 2022. Of the 3217 tweets captured, we randomly sampled 1000 eligible tweets and manually double-coded them. Interrater agreement was 83% (κ = 0.75). Results revealed six themes in the tweets, including fundraising (21.2%), advocacy (20.2%), motivational (17.5%), educational (15.3%), science (12.8%), and shout-outs (12.1%). Motivational, advocacy, and science tweets attracted more retweets than fundraising tweets and shout-outs (p < 0.001). Individuals (i.e., patients, caregivers, and advocates tweeting on their own behalf) and nonprofit organizations made a majority of the tweets at 41.5% and 38.6%, respectively, followed by health care professionals (8.7%), academic and/or medical centers (4.2%), and for-profit companies (3.5%). Childhood cancer communication on X is dominated by individuals doing advocacy and fundraising. X may provide important opportunities for public health messaging and science communication about childhood cancer.

We investigated insurance coverage among adolescents and young adults (AYA) with cancer before and during the COVID-19 pandemic. AYAs diagnosed with cancer 15-39 years of age were identified using Utah Cancer Registry records and linked with University of Utah electronic health records. Poisson models calculated incidence rate ratios (IRRs) of health insurance coverage during pre-pandemic (11/4/2017-3/5/2020; n = 2,140) and pandemic (3/6/2020-7/6/2022; n = 1,894) periods. Prior to the pandemic, insurance gaps were higher (pre-pandemic = 16.40%, pandemic = 13.73%; IRR = 0.84, 95%CI = 0.71-0.98); more AYAs had continuous public insurance during the pandemic (pre-pandemic = 8.60%, pandemic = 10.98%; IRR = 1.28, 95%CI = 1.05-1.56). Research is needed on the durability of pandemic relief programs on insurance coverage among AYA cancer survivors.

Purpose: Individuals below the age of 40 make up only 3%-11% of colorectal cancer (CRC) cases. In this study, we aimed to review clinicopathological characteristics of rectal cancer in young adults. Methods: Rectal adenocancer patients aged ≤40 were included in this study from Antalya Training and Research Hospital. A single-arm descriptive study was designed. Results: There were 85 patients in the final analyses (n = 85). The median age was 37 (19-40). Mucinous adenocarcinoma and signet-cell carcinoma rates were 11.8% for each. Twenty patients (24.4%) had high-grade cancer. Fourteen patients (16.5%) had CRC history in a first-degree relative. None of the patients were diagnosed through a screening test. Of the 85 patients, 41 (48.2%) were stage 3 and 23 (27.1%) were stage 4 at the time of diagnosis. Thirty-four (54.8%) of the 62 nonmetastatic patients had neoadjuvant and 27 (43.5%) had adjuvant treatment because of having an upfront surgery before presentation. In the nonmetastatic population, the 5-year disease-free survival rate was 69.7 ± 6.5%. De-novo metastatic underwent chemotherapy, and biological agents were administered when feasible. KRAS mutation rate was 56.5% among metastatic patients. The median progression-free survival for the first-line treatment was 11.2 months (5.7-16.6), and the median overall survival was 22.3 months (15.4-29.1). Conclusion: We demonstrated that rectal cancer is usually diagnosed at late stages in young individuals which is compatible with the previous reports. Low cancer awareness in young patients and their caregivers and adverse histological features were advocated as the reason for the diagnostic delay. However, future studies may elucidate the reason behind the common diagnosis at advanced stages.

Background: Young adult (YA) LGBTQ+ cancer survivors face inequities and unmet needs that impact their well-being. However, the impact of age and cancer among LGBTQ+ individuals have not been adequately assessed. Methods: The North Carolina LGBTQ+ Health Needs Assessment survey, conducted at local Pride events, aimed to collect data to describe the well-being of LGBTQ+ people in NC. Chi-squared tests and multivariable logistic regression models controlling for demographic factors were used to assess age and cancer-related differences in discrimination, violence, mental health, and substance use outcomes among LGBTQ+ individuals. Results: A total of N = 3170 LGBTQ+ individuals took part in the survey, n = 89 of which were YA (aged 18-39) cancer survivors and n = 111 of which were middle to older adult (M/OA, age 40+) cancer survivors. In bivariate analyses, YA LGBTQ+ cancer survivors reported significantly more LGBTQ+ violence (43.8%), sexual assault (61.4%), experiencing homelessness (33.7%), post-traumatic stress disorder (32.6%), cocaine use (16.9%), opioid use (15.7%), and having ever accidental overdose (43.8%) in comparison with YAs without a cancer history as well as M/OA with and without a cancer history. In multivariable models, YA LGBTQ+ survivors remained at elevated odds of all outcomes in comparison with M/OA survivors without a cancer history. Outcomes varied by intersecting identities among YA survivors. Conclusions: The overlap of anti-LGBTQ+ stigma and discrimination, being young, and having been diagnosed with cancer positions YA LGBTQ+ cancer survivors to experience a higher burden of serious and life-threatening outcomes.

Purpose: Many young adult (YA) breast cancer survivors (BCS) experience psychosocial distress during and after treatment, but do not utilize supportive care resources to maximize their health outcomes. The purpose of this pilot study was to test the feasibility and acceptability of a brief, internet-based expressive writing (EW) intervention intended to improve psychosocial health among YA BCS. Methods: Thirty YA BCS were remotely recruited via a hospital patient database and randomly assigned to the EW (n = 20) or neutral writing (n = 10) group. The EW intervention included delivery of positive messages and a weekly 30-minute EW activity for 3 weeks. Feasibility, acceptability, patient-reported satisfaction, and health outcomes were evaluated at baseline and 1-month follow-up. Results: The database-focused recruitment strategies (40% response) appeared to be feasible. Almost all (93%) participants adhered to at least one writing task and 67% to at least two writing tasks. Participants perceived the study as enjoyable and helpful for reducing stress. The difference in QOL of the intervention versus control group was medium to large (d = 0.73). Conclusion: This is the first study to test the feasibility of an internet-based EW for YA BCS. The online EW pilot intervention demonstrated evidence of feasibility and acceptability to YA BCS; its potential to improve health outcomes should be evaluated in an adequately powered prospective randomized controlled trial (RCT). Online EW may be offered to YA BCS in low-resource settings to address their unique physical and psychological challenges.

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.

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.

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.

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.