Childhood Cancer and Functional Impacts Across the Care Continuum (2021) / Chapter Skim
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8 The Transition from Adolescence to Young Adulthood
8 The Transition from Adolescence to Young Adulthood
Pages 389-410
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From page 389... ...
The reasons for this include fewer patients being enrolled in clinical trials, differences in approach between providers of pediatric and adult cancer care, delays in diagnosis, and psychosocial and cognitive impacts at a critical juncture of development. As is the case in younger populations, cancer symptoms may improve with therapy, but recovery may not be complete.
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. The listings describe, for each of the major body systems, impairments that SSA considers to be severe enough to cause marked and severe functional limitations in children.
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. Age-18 Redeterminations When an individual turns age 18, SSA reviews his or her eligibility to continue receiving SSI benefits based on the SSA disability determination process for adults.
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. EPIDEMIOLOGY OF CANCERS IN ADOLESCENTS AND YOUNG ADULTS While the disability determination process changes abruptly at the age of 18, the epidemiology of cancers across the AYA age range shows a gradual transition in cancer types and incidence from childhood to adulthood.
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SOURCE: National Cancer Institute's Surveillance, Epidemiology, and End Results Program for the period 1990–2016. FIGURE 8-2 Sex-specific annual U.S.
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Leukemias 42.2 31.8 28.5 26.9 26.4 Acute lymphoid leukemia 9.5 19.1 13.4 9.8 7.7 Acute myeloid leukemia 12.6 9.3 10.2 10.8 10.9 Chronic myeloid leukemia 6.5 2.2 3.1 4.6 5.7 Other and unspecified leukemia 3.9 1.3 1.8 1.7 2.2 II. Lymphomas 80.8 46.7 60.7 72.4 76.4 Non-Hodgkin lymphoma 42.6 18.9 20.4 26.2 31.4 Hodgkin lymphoma 38.2 27.8 40.3 46.2 45.1 III.
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Soft-Tissue Sarcomas 29.7 15.1 15.1 19.1 24.1 Fibromatous neoplasms 7.5 3.1 3.3 5.1 6.6 Rhabdomyosarcoma 1.6 4.0 2.5 1.5 1.1 Other soft-tissue sarcoma 20.5 8.0 9.3 12.5 16.5 VI. Germ Cell and Trophoblastic Neoplasms 60.5 21.8 40.4 59.9 72.9 Germ cell and trophoblastic neoplasms of gonads 56.0 16.8 35.5 55.1 67.5 Germ cell and trophoblastic neoplasms of nongonadal sites 4.5 4.9 5.0 4.8 5.3 VII.
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SOURCE: National Cancer Institute's Surveillance, Epidemiology, and End Results Program for the period 1990–2016.
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, but have not focused on the risk for those aged 15–19 years -- the early AYAs on whom this report focuses. In the British Teenage and Young Adult Cancer Survivor study, in which 12,248 survivors of childhood cancer treated for their primary cancer between the ages of 15 and 19 years were observed, 622 (5 percent of survivors)
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cancer and matched survivors of childhood cancer by attained age and time since diagnosis.
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Additionally, the U.S. Food and Drug Administration has issued guidance to the pharmaceutical industry, clinical investigators, and institutional review boards to facilitate the inclusion of patients aged 12–17 in relevant adult oncology clinical trials (FDA, 2019)
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Many of the physical, cognitive, and psychosocial late effects seen in survivors of childhood cancer across the childhood age spectrum are described in Chapter 4. These survivors have a more than fourfold risk of developing severe and disabling, life-threatening, or fatal chronic health conditions compared with siblings of the same age (hazard ratio [HR]
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FUNCTIONAL IMPACTS UNIQUE TO ADOLESCENCE AND YOUNG ADULTHOOD The AYA period is important for two populations: those who are diagnosed with cancer in this age range and those who are diagnosed prior to this age range but are survivors during this period and subject to chronic and late effects. AYAs, both those with a diagnosis as an AYA and survivors of a childhood diagnosis, experience functional impacts distinct from those of children and adults.
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From page 402... ...
Approximately one-quarter of the studied AYA survivors reported that cancer and its treatment made job-required physical tasks more difficult, and approximately 14 percent reported finding job-required mental tasks more difficult, a challenge to employment goals. Not being employed is linked to mental distress in several of the reviewed studies discussed below.
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describe studies finding sexual functioning problems in survivors that exceeded those reported by their age peers who had not experienced cancer. Female survivors reported a greater frequency of sexual functioning problems, while males reported higher distress secondary to their sexual functioning problems.
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. These persistent cognitive impairments can impact all of SSA's functional equivalence domains: acquiring and using information, attending and completing tasks, interacting and relating with others, moving about and manipulating objects, caring for oneself, and health and physical well-being.
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8-8 Survivors of AYA cancers are at higher risk of anxiety, depres sion, and distress compared with age cohorts who have not experienced cancer. 8-9 Current guidelines recommend annual assessments to detect late effects, subsequent cancers, and emotional distress in these young survivors, as well as periodic neuropsychological assessments.
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2017. Health promotion and psychological interventions for adolescent and young adult cancer survivors: A systematic literature review.
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2016. Cognitive, behavior, and academic functioning in adolescent and young adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study.
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2013. Recommendations for breast cancer surveil lance for female survivors of childhood, adolescent, and young adult cancer given chest radiation: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.
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2020. Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: A retrospective cohort analysis from the Childhood Cancer Survivor Study.
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