Despite cancer survival rates increasing dramatically for children and older adults in the last 20 years, there has been minimal improvement in the survival rates in the Adolescent and Young Adult (AYA) population, an age range defined as 15 – 29 years by the presenters. A lack of participation in clinical research trials, biological differences of the disease, limited resources of this age group, and fragmented treatment by pediatric and adult oncologists are some of the reasons for the lack of progress within this patient population according to physicians who recently presented an overview of AYA oncology at the NCCN 15th Annual Conference.
“Today, more than twice as many AYA patients than children under the age of 15 die of cancer. The dramatic progress made in the last three decades in curing children has not been seen in the AYA age group.”
“Cancer is the leading cause of death from disease in adolescents and young adults in the United States. Although 20,000 new cases are diagnosed each year — twice as many as in children under 15 — programs tailored to this population simply have not developed as they have for children,” noted Peter F. Coccia, MD of UNMC Eppley Cancer Center at The Nebraska Medical Center.
Dr. Coccia underscored the impact further stating, “Today, more than twice as many AYA patients than children under the age of 15 die of cancer. The dramatic progress made in the last three decades in curing children has not been seen in the AYA age group.”
“Traditionally, care of adolescent and young adult patients has been widely dispersed among pediatric and medical oncologists, which creates inconsistencies in treatment approaches,” echoed Nita Seibel, MD of the National Cancer Institute.
The large disparity of outcomes between children and the AYA population can be attributed to their lack of participation in clinical trials or not being referred to a cancer center to be offered a clinical trial or treatment approach with the best outcome.
Dr. Seibel explained that research shows that survival rates directly correlate with the level of participation in clinical trials and AYAs are the least likely group to participate in clinical trials. On the contrary, more than 90 percent of patients under the age of 15 years are managed by multidisciplinary teams using standardized treatment approaches in centers participating in the Children’s Oncology Group (COG) clinical trials.
“Older adolescent cancer patients have far less participation in clinical trials than younger patients due to a lack of knowledge of the specialized services available for these patients,” said Dr. Coccia.
Low participation rates in clinical trials are compounded by the lack of consistency in the approach to treatment in addition to scarcity of specific outcome data on AYAs noted the presenters.
In the age range of 15 – 29 years, some patients are treated by pediatric oncologists while others are managed by medical oncologists who traditionally have had different treatment approaches to their care.
However, research has shown that treating AYA patients with a “pediatric-directed approach” tends to lead to improved outcomes, most dramatically in patients with acute leukemia as well as bone and soft tissue sarcomas.