Older adolescents with cancer in North America: Deficits in outcome and research
Introduction
The progress in the treatment of children with cancer that has occurred during the past half century has been among the most dramatic advances in the history of medicine. However, older adolescents and young adults with cancer have not had comparable benefit; for example, improvement in the survival rate in young adults has not kept pace with that achieved in younger patients. In addition, the physical, emotional and social challenges posed by cancer in adolescence and early adult life are unique and often the most difficult faced by patients, families and health care providers. In contrast with advancements in caring for both younger and older patients with cancer, there has been no effort, until recently, in the United States and Canada to address the dilemma faced by adolescents and young adults, even though cancer develops in nearly 50% more people in the 15- to 19-year age group than in those who are younger than 15 years. This brief review summarizes data that support these contentions and recommend increased clinical trials and a specific research agenda for cancer patients in the 15- to 19-year age group. A more complete treatise by the author is available elsewhere [1].
Section snippets
Incidence
Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) indicate that during the 1990s, there were 203 new cases per year per million persons 15 to 19 years of age in the United States [2], which was 1.4 times higher than the incidence of cancer in children and younger adolescents less than 15 years of age. Further, although the incidence of cancer in 15- to 19-year-olds is similar to the incidence of cancer among 0- to 4-year-olds in the
Relative change in mortality rates
The average annual percentage reduction in the mortality rates declined between 1975 and 1998 in all age groups under 20 years of age (Fig. 3). This occurred despite an increase in incidence of approximately equal magnitude in each age group. The magnitude of the change is least apparent in the adolescents, however, and particularly in the older adolescents and particularly during the last half of the interval, from 1987 to 1998 (Fig. 3). The relative stable incidence rate in 15 to 19 year-olds
Lack of inclusion in clinical trials
More than 90% of children younger than 15 years with cancer are treated at institutions that participate in NCI-sponsored clinical trials in the United States and Canada. In contrast, only about 20% of 15- to 19-year-olds with cancer are treated at such institutions, and only about 10% are entered into a clinical trial (Fig. 6) [3], [16]. Among 20- to 29-year-olds, the inclusion rate is even lower, with fewer than 10% treated at member institutions of the cooperative groups, either pediatric or
Conclusions and recommendations
Coping with cancer during adolescence or young adulthood is considerably more difficult and demanding than during other stages of life. Compounding this problem is evidence that progress in diminishing the cancer problem in older adolescents and young adults has lagged behind the progress made with younger patients. The relative lack of inclusion of older adolescents in clinical trials of cancer therapy explains, at least in part, the relative lack of progress.
Although the need for adolescent
Summary
In the two decades from the mid 1970s to the mid 1990s, the proportion of 5-year survivors among children in North America with cancer has increased nearly 40%. Advances in otherwise fatal leukemias, lymphomas, sarcomas, brain tumors, germ cell neoplasms and cancer of the kidney account for much of the improvement. Unfortunately, older adolescents have not fared as well. Their epidemiological, medical, physical, psychological and social needs remain largely unmet despite their age juxtaposition
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