Northeast Florida Medicine
Vol. 66, No. 2 2015
47
Pediatric Oncology
Adolescent and Young Adult Oncology: Addressing a Need
By Scott M. Bradfield, MD
Adolescent and Young Adult (AYA) Oncology spans the
typically distinct arenas of pediatric and adult oncology.
Adolescence and young adulthood are two developmental
stages that distinctly impact the care of these patients psy-
chologically, socially, financially, and developmentally.This
group has been defined in various ways, but 15-30 years
of age is a commonly chosen range. AYA patients are beset
with a shocking diagnosis in the midst of a developmental
period where they are sorting out and creating their own
separate identity. The sudden dependence on medical
professionals and their parents for care and support can
be a major interruption leading to anger, non-adherence,
and/or depression and maladjustment. The field of AYA
oncology has emerged to appreciate these specific issues
and provide avenues for developmentally-appropriate
adjustment throughout treatment and survivorship.
Recognition of this field is an attempt to highlight and
better understand the uniform findings, as well as the
differences, across this stage of development.
Adolescents and young adults have cancers that are
biologically distinct. Epidemiologically, they have an in-
creased incidence of Hodgkins lymphomas, brain tumors,
bone tumors, thyroid carcinomas and germ cell tumors
compared to younger children.
1,2
Among the diagnoses that
are shared, a variety of differences are seen biologically. In
patients with acute lymphoblastic leukemia (ALL), higher
risk chromosome abnormalities are found more often,
while more favorable translocations are seen tenfold fewer
times.
3
Germ cell tumors in AYA patients more commonly
contain isochromosome 12p (a specific germ cell tumor
abnormality), and behave more aggressively than in their
pre-pubertal counterparts.
4
Others have shown poorer
survival rates in osteosarcoma, Ewings sarcoma and acute
myeloid leukemia (AML).
5
In addition, AYA patients have
been found to disproportionately suffer from a number
of specific treatment toxicities such as avascular necrosis,
transplant-related mortality, mucositis, infections and
peripheral neuropathy.
5
The overlap of a distinct biology
with the psychosocial difficulties at this stage has led, in
ways not yet understood completely, to the AYA patient
group lagging in survival improvements compared to
younger and older patients.
2,6
One area of interest has been attempting to analyze
differences in survival when AYA patients are treated in
pediatric versus adult facilities and by their corresponding
practitioners. Reviews of survival outcomes have shown
consistently that adolescent patients treated on pediatric
chemotherapy regimens for acute lymphoblastic leukemia
have a survival advantage.
3,7
Retrospective comparisons
revealed seven year overall survival of 67 percent of patients
on Children’s Cancer Group (CCG) pediatric protocols,
compared with only 46 percent on Cancer and Leukemia
Group B (CALGB) adult regimens.
7
Further delineation
showed earlier and more intensive central nervous system
prophylaxis and higher cumulative doses of nonmyelo-
suppressive agents as a major difference.
7
In other cases,
where aggressive regimens are used at adult centers, these
differences were somewhat evened-out.
8
In another review, AYA patients were shown to have
improved survival when treated for AML on pediatric
regimens compared to adult cooperative group studies.
9
Suggested reasons for these findings include protocol design
and intensity, patterns of referral and entry to clinical trials,
treatment compliance due to maturing development and
autonomy transitions, different practices for the allowance
of emerging educational, family and workplace needs, as
well as supportive care practices.
2,3
With such a convincing amount of evidence emerging
in the literature that differentiates this population, the
evolving discipline of AYA oncology needed to be ad-
Address correspondence to:
Scott M. Bradfield, MD
Associate Division Chief, Pediatric Hematology/Oncology
Nemours Children’s Clinic - Jacksonville
807 Children’s Way
Jacksonville, FL 32207
Abstract:
Adolescent and Young Adult (AYA) Oncology represents
a new field in oncology practice acknowledging the specific
developmental stages patients are going through and the impact
those stages have on their care- psychologically, socially, financially,
and developmentally. A newly-developed AYA program is available
to Northeast Florida patients. It is called C.H.A.T., which stands
for Cancer·Healing·Adolescents·Talking. This program, of the
Nemours Children’s Clinic / Wolfson Children’s Hospital Pediatric
Cancer Program, provides psychosocial support, peer “ambassadors,”
educational sessions, age-appropriate equipment, fertility preservation
opportunities, vocational counseling and research studies.
