Initiatives to improve adolescent, young adult cancer outcomes justified

By Shreeya Nanda

Analysis of the EUROCARE-5 data shows that although survival for adolescents and young adults (AYAs) with cancer has improved overall, the survival rates for certain malignancies still lag behind those for children.

These findings justify initiatives implemented in several European countries to improve outcomes for AYAs, such as "the promotion of collaboration between paediatric and adult oncologists, development of national policies for managing AYAs with cancer, and setting up of AYA-specific treatment units", say Annalisa Trama (Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy) and team.

Using data from population-based cancer registries of 27 European countries, they identified 312,483 diagnoses of cancer in AYAs (individuals aged 15-39 years as per the latest US National Cancer Institute definition) between 2000 and 2007. During this same period, the registries recorded 56,505 cancer diagnoses in children (0-14 years) and 3,567,383 in adults (40-69 years).

Five-year relative survival rates for all cancers combined improved significantly over time for AYAs and children, from 79% in 1999-2002 to 82% in 2005-2007 for AYAs and from 76% to 79% for children.

But this overall improvement masks the differences between AYAs and children for specific malignancies. For instance, the 5-year relative survival rate for acute lymphoid leukaemias was significantly lower for AYAs than for children, at 55.6% versus 85.8%.

This was also the case for acute myeloid leukaemias (49.8 vs 60.5%), Hodgkin's lymphoma (92.9 vs 95.1%), non-Hodgkin's lymphoma (77.4 vs 83.0%), astrocytomas (46.4 vs 61.9%), Ewing's sarcoma of bone (49.3 vs 66.6%), rhabdomyosarcoma (37.8 vs 66.6%) and osteosarcoma (61.5 vs 66.8%).

By contrast, AYAs had significantly better survival than paediatric patients for medulloblastomas and germ-cell tumours, with rates of 69.3% versus 63.2% and 94.7% versus 91.5%, respectively.

AYAs also had better 5-year relative survival rates than adults for most carcinomas; the exceptions were colorectal, penile and lip cancers, for which the rates were similar, and breast and prostate cancers, where AYAs fared worse than adults.

They researchers write in The Lancet Oncology that "[t]he time period of our analyses pre-dates implementation of the European initiatives to improve outcomes for AYAs, and thus provides an important baseline from which to assess the effectiveness of these initiatives."

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