As with cancer patients of any age, young adults can see significant changes in their life after a cancer diagnosis, including disruption of school and career.
Adolescents and young adults (AYAs) who are diagnosed with cancer in the US face significant and unique health issues, including disparities in care, which could affect their survival rate. A new study looking at cancer patients aged 15-39 explores these issues and possible ways to improve treatment.
According to the study from the American Cancer Society, cancer research for AYAs can be problematic because types of cancer diagnoses and incidence of cancer show variation as adolescents become adults. And this age group has been somewhat overlooked, the study said, partly because it falls between well-defined groups—pediatric cancer patients and adult cancer patients. At the time of diagnosis, many of these patients are transitioning between getting care from providers of pediatric care and providers of adult care. In addition, since younger adults are more likely to uninsured than any other age group, lack of insurance coverage is also an important factor in access to care.
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As with cancer patients of any age, AYAs can see significant changes in their life after a cancer diagnosis. These include disruption of school and career, along with possible changes in function and appearance. Issues with fertility, sexual dysfunction, and body image are common, especially among women. A significant percentage of young women (38%) and men (18%) report not being informed of fertility preservation options.
"Among AYA survivors who need specific services, a high proportion report a variety of unmet needs within a year after diagnosis, such as access to a mental health professional (56%), cancer rehabilitation (58%), or pain‐management services (63%)" the study said.
Racial disparities among AYAs with cancer
The report estimated that nationally, this age group will see 89,500 cases and 9,270 deaths in 2020. Racial disparities, found in many areas of health care in the United States, are also found in cancer cases in this age group: female breast cancer incidence rates in non-Hispanic Black AYAs are 14% higher than those in non-Hispanic white AYAs. In addition, cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females (12.6 per 100,000 vs 9.2 in non-Hispanic white persons), reflecting disparities in cancer survival rates compared to those who are non-Hispanic white.
"By age group, the cancer incidence rate in AYAs increased during the most recent decade (2007-2016) overall but showed signs of stabilizing among men in their 20s. The rise is largely driven by thyroid cancer incidence rates, which rose by approximately 3% annually among those aged 20 to 39 and 4% among those aged 15 to 19 years. Incidence increased for several cancers linked to obesity, including kidney, uterine corpus, and colorectum," the study found.
Although incidence of cancer went up with this age group, mortality for all cancers has declined, the study said. Rates of breast cancer mortality among women remained flat, mirroring incidence, and mortality rates for colorectal and uterine corpus cancers has increased over the past ten years.
"Leukemia continues to be the leading cause of cancer death in ages 15 to 29 years. Among ages 30-39 years, breast (women) and colorectal (men) cancers are the leading cancer causes of death," the report said. "Overall 5-year relative survival in AYAs for all cancers combined (83%-86% across age groups) is similar to that in children (84%), but masks lower survival for several cancer types, such as acute lymphocytic leukemia.
Findings suggest unique outcomes for AYAs
The report said there is a growing body of evidence that tumors in AYAs are molecularly different than those in children or older adults. This may require different or tailored approaches when looking at causes and treatments of cancers for this age group.
The study also said progress in reducing cancer morbidity and mortality among this age group could be improved by addressing health disparities and enabling more equitable access to health care. The researchers also called for increased clinical trial enrollment, expanded research, and improved awareness among clinicians and patients of early symptoms and signs of cancer.
"Although there has been rapid progress in the scientific understanding of cancer in AYAs over the last decade, several research gaps in etiology, basic biology, treatment, and survivorship remain," the report concludes. "AYAs diagnosed with cancer also continue to face challenges in health care access during early life transitions, which can negatively impact treatment."
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