Onkologische Erkrankungen bei Jugendlichen und jungen Erwachsenen – Zahlen aus dem Klinischen Krebsregister Rostock als Arbeitsgrundlage für eine interdisziplinäre Herausforderung

 

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Zusammenfassung

Fragestellung: Jugendliche und junge Erwachsene stellen eine Minderheit unter den Patienten mit malignen Erkrankungen dar. Ihr Gesamtüberleben hat sich in den letzten beiden Jahrzehnten – anders als das jüngerer oder älterer Patienten – kaum verbessert. Ob dies an Unterschieden der Tumorbiologie und der Therapiekonzepte oder an besonderen psychosozialen Bedingungen mit einer schlechteren Compliance und Versorgungsqualität liegt, ist unklar. In der vorliegenden Untersuchung wurden deshalb alle 15- bis 39-jährigen Patienten des Klinischen Krebsregisters Rostock der vergangenen 10 Jahren analysiert, um nachfolgend ein interdisziplinären Therapie- und Begleitungskonzept erarbeiten zu können. Ergebnisse: Es wurden bei einer geschätzten 93 %-igen Erfassungsrate 2164 Fälle aus einer Region von ca. 570 000 Einwohnern erfasst. Die Erkrankungshäufigkeit nimmt in jeder 5-Jahres-Alterskohorte zu: Unter 5 % waren 15 – 19 Jahre alt, über 40 % 35 – 39 Jahre. Das Diagnosen-Verteilungsmuster ändert sich gleitend. In der jüngsten Kohorte überwogen hämatolymphatische Erkrankungen, Hirntumoren und Sarkome, in den mittleren Alterskohorten die Melanome und Tumoren des inneren weiblichen Genitales und erst bei der hohen Alterskohorte traten Karzinome außerhalb der Geschlechtsorgane nennenswert hervor, auch hier stellten sie nicht jedoch die Hauptgruppe dar. Die Carcinoma-in-situ-Erkrankungen der Zervix junger Frauen umfassten rund ein Viertel des Gesamtkollektivs. Obwohl die großen Kliniken in der Region zentral an Meldung und Betreuung der Patienten beteiligt waren, wurden rund 40 % von niedergelassenen Ärztinnen und Ärzten, von kleinen oder auch wohnortfernen Kliniken gemeldet. Schlussfolgerung: Jugendliche und junge Erwachsene weisen tumorbiologische und psychosoziale Unterschiede gegenüber Kindern und Erwachsenen auf, die neue interdisziplinäre Therapie- und zentralisierte Betreuungskonzepte erfordern.

Abstract

Background: Adolescents and young adults represent a minority among cancer patients. In contrast to younger or older patients, their overall survival did not improve considerably in the last two decades. It is unknown whether this is due to different tumour biology or therapy concepts, or to particular psychosocial conditions in this age group, leading to reduced compliance or quality of care. Thus, the therapy of cancer in adolescents and young adults represents a particular challenge. In order to establish new concepts for the interdisciplinary therapy, in the following study all patients from 15 to 39 years of age reported to the clinical cancer registry Rostock in the last ten years were analysed. Results: With an estimated reporting rate of 93 per cent, 2164 cases from a region of about 570 000 inhabitants were collected. The cancer incidence increases from each age cohort to the next: less than 5 % were 15 – 19 years old, more than 40 % 35 – 39 years. The distribution pattern of diagnoses changed continuously: In the youngest cohort, hematolymphatic diseases, brain tumours and sarkomas predominated, in the middle age cohort we saw a large number of melanomas and tumours of the inner female genitalia, and only in the high age cohort carcinomas outside the genitalia appeared more commonly, still representing a minority. Especially, the carcinomas in situ of the cervix uteri in young women included about one fourth of the whole patient group. Although, as expected, the large hospitals of the region predominated in reporting and therapy of the patients, about 40 per cent of the young patients were reported by physicians outside the hospitals, or by hospitals distant to the home regions of the patients. Conclusions: Adolescents and young adults show both biological and psychosocial differences compared to children and older adults. To better meet these challenges, new interdisciplinary concepts of therapy and care are needed. This study shows that treatment in this age group currently usually is not done in centralized way.

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PD Dr. med. Carl Friedrich Classen

Universitäts-Kinder- und Jugendklinik Rostock

Ernst-Heydemann-Str. 8

18057 Rostock

Phone: ++ 49/3 81/4 94 72 62

Fax: ++ 49/3 81/4 94 72 61

Email: carl-friedrich.classen@med.uni-rostock.de