NCCN issues new guidelines for AYA oncology patients

The National Comprehensive Cancer Network^® (NCCN^®) announces that it has issued new NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Adolescent and Young Adult (AYA) Oncology. AYA patients are defined in the guidelines as individuals 15 to 39 years of age at initial cancer diagnosis. The guidelines address the critical issues that AYA patients with cancer and their caregivers encounter at diagnosis, during treatment, and after therapy.

According to the American Cancer Society's Cancer Journal for Clinicians, remarkable progress has been made in the treatment of children under the age of 15 and in adults over 40 years of age in the last 35 years, but there has been minimal improvement in the survival rate in the 70,000 new AYA patients with invasive cancer diagnosed yearly.

"There is an urgent need for increased awareness of the many unique issues responsible for these poor outcomes in the AYA oncology patients," Peter F. Coccia, MD, of the UNMC Eppley Cancer Center at The Nebraska Medical Center, chair of the NCCN AYA Oncology Panel and a member of the NCCN Board of Directors noted. "Patients in this age group with pediatric types of cancers such as acute lymphoblastic leukemia and bone and soft tissue sarcomas have better outcomes when treated with aggressive therapies utilized by pediatric oncologists. We also see worse outcomes for AYA patients diagnosed with adult onset cancers such as breast and colon cancer. We hope and believe that the new NCCN Guidelines^® for AYA Oncology will make a difference in how these patients are managed throughout the course of their disease."

The NCCN Guidelines address the many factors responsible for the disappointing results in the AYA patients. In the United States, only about 10 percent of 15 - 19 year old patients and 1 - 2 percent of 20 - 39 year old patients enroll in clinical trials. Conversely, more than 90 percent of children under 15 years of age are managed in centers that participate in the Children's Oncology Group (COG) protocols or clinical trials. In addition, AYA patients more often lack adequate health insurance, and may not have access to either routine health care, which leads to earlier diagnosis, or to state-of-the-art care once diagnosed. Moreover, AYA patients tend to be less compliant with their prescribed treatments.

The NCCN Guidelines Panel, made up of experts in AYA oncology from the 21 NCCN Member Institutions, strongly advises that AYA patients be referred to cancer centers with expertise and experience in treating patients in this age group and the cancers that affect them. They cite improved enrollment in clinical trials, the need for a multidisciplinary approach to treatment, and specific attention to the special physical and psychosocial issues that AYA patients face as critical components in delivering state-of-the-art care.

The NCCN Guidelines include recommendations for fertility preservation; screening recommendations for late effects after successful completion of therapy; palliative care and end-of- life considerations for patients who fail curative therapy; and detail the available on-line resources for AYA patients and cancer survivors.

Bradley J. Zebrack, PhD, MSW, MPH, of the University of Michigan Comprehensive Cancer Center, a member of the NCCN AYA Oncology Panel, stresses the importance of understanding and managing psychosocial issues for these patients.

"Psychological distress is significantly greater among AYA patients as compared to younger children or older patients with cancer. These patients face serious problems related to loss of fertility, disruptions in their education or their careers, and their social interactions--in addition to the threat to their mortality. These issues, and the isolation that accompanies them, can affect their lives for many years. Managing these patients medically and communicating effectively with them can be challenging, and requires that the full team of health care providers be knowledgeable about adolescent behavior. The team must also be well trained in how to communicate with teens and young adults, as well as their families and peers. The new NCCN Guidelines include a comprehensive psychosocial assessment to assure that these issues are fully addressed."

The NCCN Guidelines for AYA Oncology will be presented next week at the NCCN 17^th Annual Conference: Clinical Practice Guidelines & Quality Cancer Care™.