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Feature Article

Adolescents, young adults and cancer: what GPs need to know

MICHELLE NG, VHARI FORSYTH, Toby Trahair, NIGEL CARRINGTON, ANTOINETTE ANAZODO
OPEN ACCESS

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Abstract

GP care for adolescents and young adults with cancer can be vital for the wellbeing of patients through their diagnosis, treatment and follow up. It is important for GPs to be familiar with cancer services for this age group, including services that provide age-appropriate medical, nursing and psychosocial care.

Key Points

  • GPs have an important role in providing care for adolescents and young adults (AYAs) with cancer, and their role should be encouraged, even for patients with complex needs.
  • Dedicated AYA support services are essential for delivering developmentally and age-appropriate care to AYA patients, whose needs are significantly different from those of younger and older patients.
  • CanTeen administers the Federal and State Government-funded age-specific Youth Cancer Services across Australia for cancer patients between 15 and 25 years of age.
  • Challenges when caring for this age group include understanding the differences in cancer biology and the complex psychosocial needs of AYAs, and enabling participation in clinical trials and research.
  • Young people attend their GP frequently but consultations involving symptoms related to cancer are rare. The Early Detection of Cancer in AYAs guideline has been developed for primary health professionals involved in the management of AYAs with cancer.
  • Although cancer in the AYA age group is rare, a cancer diagnosis is the most common cause of death in this age group after accidents, murders and suicides.

    Picture credit: © Rubberball/Jessica Peterson/Diomedia.com
    Model used for illustrative purposes only

The adolescent and young adult (AYA) population in Australia is defined as people between 15 and 25 years of age. Data from the 2012 Census of Housing and Population show that young people in this age range account for 14% of the Australian population. Fifty-one per cent of them are male, 72% live in a major city, 42% live at home, 19% live in the lowest socioeconomic status quintile and 24% are unemployed.1

During this period of their life, AYAs normal experience significant change as they undergo transition from childhood into adulthood.2 It is a period of significant physical, cognitive and emotional change, meaning that the psychosocial needs of this age group differ substantially from those of younger or older patients. AYAs start to experience an awareness of their body image and sexuality, and many are experiencing relationships for the first time. At the same time, they are meeting the demands of high school or university education, vocational training or entering the workforce for the first time. This is also a period in which a young person’s auton-omy is developing and they are balancing a need for independence with parental nurturing. Increased risk-taking behaviour and involvement in activities they have never before attempted are absorbing young people’s attention, as they construct a platform for early adult life. With all these novel experiences, young people experience significant pressure and many struggle with mental health problems (just over one-quarter of people between 16 and 24 years of age have some form of mental health disorder).3

Understanding these psychological and social factors for the AYA population in Australia (as well as what constitutes normal development) is very important to be able to meet the complex care needs of AYA patients when they are diagnosed with cancer. Given that these issues describe normal development in AYAs, they will also influence how an AYA handles an acute and chronic illness, their care-seeking patterns and their adherence to recommended treatment and follow-up care.

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The World Health Organization presented a detailed report, Health for the World’s Adolescents to the World Health Assembly in 2014.4 It clearly identified the growing and specific attention needed for services providing adolescent health care, which are distinct from those required by children’s and adult health services. This was followed up with The Lancet commission on adolescent health and wellbeing in 2016, which emphasised the health and wellbeing benefits that improvements in adolescent health lead to, and the longer term benefits that continue into adult life.5

Statistics on cancer in adolescents and young adults in Australia

Each year, about 950 Australian AYAs are diagnosed with cancer.6 There are almost twice as many AYAs diagnosed with cancer each year as children under 14 years of age. Cancer in AYAs is very rare, making up only 1.7% of all people diagnosed with cancer in Australia. The incidence of cancer in AYAs continued to increase by 1.5% per year until 1996 and has not changed significantly since then.

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AYAs have a five-year relative survival rate of 88% and, although this varies by tumour group, survival for most tumour types has increased over the past 20 years, with the highest increases seen in acute leukaemias.6 Despite improvements in survival rates for AYAs with cancer, the survival improvements have not matched the improvements seen in paediatric or adult cancer types. A cancer diagnosis, although rare, is the most common cause of death in this age group, after accidents, murders and suicides.

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Dr Ng is a Fellow at the Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW. Dr Forsyth is a Registrar at the Kids Cancer Centre, Sydney Children's Hospital. Dr Trahair is a Paediatric and Adolescent Oncologist at the at the Kids Cancer Centre, Sydney Children's Hospital; and a Senior Lecturer at the School of Women’s and Children’s Health, UNSW Sydney. Mr Carrington is the Youth Cancer Service Manager at the Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney. Dr Anazado is a Paediatric and Adolescent Oncologist at the Kids Cancer Centre, Sydney Children's Hospital, and the Nelune Comprehensive Cancer Centre, Prince of Wales Hospital; and a Senior Lecturer at the School of Women’s and Children’s Health, UNSW Sydney, Sydney, NSW.