Is the Adolescent and Young Adult Cancer Survivor at Risk for Late Effects? It Depends on Where You Look.

Abstract

The adolescent and young adult (AYA) population is a growing group of survivors, exceeding more than 600,000, at high risk for late effects of cancer-directed therapy. While many guidelines exist for cancer survivorship care, choosing which to use for an AYA cancer survivor is challenging, yet vital, to ensure comprehensive follow-up care. Survivorship care plans (SCPs), including treatment summaries (TS) and follow-up care plans, were created for three clinical vignettes (acute lymphoblastic leukemia, osteosarcoma, and Hodgkin lymphoma). Four sets of guidelines were used, including the Children's Oncology Group Long-Term Follow-Up Guidelines (COG LTFU), National Comprehensive Cancer Network (NCCN) Guidelines for Age- Related Recommendations: AYA Oncology (NCCN-AYA), NCCN Guidelines for Treatment of Cancer by Site (NCCN-Site), and NCCN Guidelines for Supportive Care: Survivorship (NCCN-Survivorship) and NCCN supplemental cancer screening guidelines. The follow-up care plans were compared across guidelines to determine the extent and nature of the similarities and differences concerning AYA cancer survivorship care. The guidelines disagree on the link between treatment exposures and late effects, the population to be screened, the screening test to be used, and the time interval of testing. Specific examples of this include screening for cardiac toxicity, breast cancer, and neurocognitive deficits. While many guidelines exist for AYA survivorship care, there is discordance among the recommendations. This has significant implications for the long-term follow-up care of an AYA survivor. This study offers solutions to harmonize guidelines in order to ensure comprehensive quality survivorship care for this population.