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The Oncologist, the Patient and CKN — Sharing Knowledge

Developing a Program for Adolescents and Young Adults (AYA) with Cancer

AbhaGuptaby Dr. Abha A. Gupta

 

Adolescents and young adults (AYA) with cancer are a constituency of patients facing unique disparities of care affecting their quality of life and treatment outcomes. These needs differ from those of the average adult cancer patient.  Currently, most adult institutions do not adequately and consistently meet the needs of this vulnerable population that fall between the pediatric and adult oncology systems’ structures[1].

According to the National Cancer Institute of Canada, AYA patients are defined as those adults between the ages of 18-39[2].  The prevalence of AYA cancers are rarer and more diverse (ie. lymphoma, germ cell tumours, sarcomas) than those affecting older adults (lung, colon).  As cancer treatment is organized around organ system of origin (i.e. breast, hematology, genitourinary) the AYA patients span multiple sites are not recognized as a group with unique needs. There is a high cure rate for many of these cancers, so dealing with longer term physical and psychological effects of cancer and its therapy is another challenge[3],[4].

 

Unlike the average adult at the time of diagnosis, AYA patients are transitioning through important milestones in their lives like education, marriage, family planning, and employment and therefore have unique concerns about the impacts of their cancer treatment.  As well, current treatment decisions are also influenced by their life goals[5],[6],[7].

 

In 2010, a survey was conducted among 250 AYA patients at Princess Margaret Cancer Centre.  Respondents identified the following 4 areas to be of greatest importance to them: 1) information on their cancer, 2) fertility preservation, 3) diet and nutrition, and 4) exercise[8].  We are currently in the process of rolling out a dedicated AYA Program at Princess Margaret.  This program will ensure the development of clinical pathways which will provide a standardized approach for holistic counseling to address psychosocial, diet and nutrition, exercise, cancer education, sexuality, fertility preservation, tissue banking, facilitate enrolment into clinical trials and concerns regarding financing and returning to work or school.   



[1] Conrad Fernandez, Graeme A.M. Fraser, Carolyn Freeman, Eva Grundelf, Abha Gupta, Leslie Stephen Mery, Jonja De Pauw, and Brent Schacter for the Canadian Task Force of AYA with Cancer.  Journal of Adolescent and Young Adult Oncology. Vol 1. 2011

[2] National Cancer Institute.  http://www.cancer.gov/cancertopics/aya Accessed March 2013

[3] Cancer Care Ontario: Cancer in Young Adults in Canada T, Canada, 2006. May 2006  http://www.phac-aspc.gc.ca/publicat/cyac-cjac06/pdf/cyac-cjac-2006_e.pdf

[4] Bleyer WA. Cancer in older adolescents and young adults: epidemiology, diagnosis, treatment, survival, and importance of clinical trials. Med Pediatr Oncol 2002;38(1):1-10.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11835231

[5] Hokkanen H, Eriksson E, Ahonen O, Salantera S. Adolescents with cancer: experience of life and how it could be made easier. Cancer Nursing 2004;27(4):325-35.

[6] Bauld C, Anderson V, Arnold J. Psychosocial aspects of adolescent cancer survival. J Paediatr Child Health 1998;34(2):120-6. Available from
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9588632

[7] Thomas DM, Albritton KH, Ferrari A. Adolescent and young adult oncology: an emerging field. J Clin Oncol;28(32):4781-2. Available from
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20733122

[8] Gupta et al. Supportive Care in Cancer, in press 2013

 


 

Dr. Abha Gupta received her MD at the University of Toronto.  She completed her pediatrics residency at Yale New Haven Children’s Hospital (New Haven, CT) and Children’s Hospital of Eastern Ontario (Ottawa) before moving back to Toronto to complete her fellowship in paediatric hematology/oncology at The Hospital for Sick Children.  To complement her training, Dr. Gupta completed a one-year fellowship in Adolescent and Young Adult Oncology with a focus on sarcoma.  She is currently cross appointed as a staff oncologist at both The Hospital for Sick Children and Princess Margaret Hospital.  

Dr. Gupta’s primary clinical and research interests include sarcoma, adolescent oncology, and primary liver tumours in children.

 

 

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