Preface

Abstract

Adolescents with cancer have been described as the “lost tribe,”1 for they do not fit well into either the conventional pediatric or the adult-oriented health care systems. Defined as those patients ages 15 years to 19 years,2 these individuals are accommodated imperfectly by both structures, a circumstance that has stimulated the consideration of a “third way.” In the U.K., a nongovernmental organization, the Teenage Cancer Trust (TCT), has spearheaded the establishment of a growing network of centers devoted specifically to the care of these young people with malignant disease.3 Accordingly, it was deemed appropriate that, in November 2003, the annual symposium of the Pediatric Oncology Group of Ontario address the topic “Adolescent and Young Adult Oncology—Walking Two Worlds,” with the intention of exploring this conundrum in an open forum of the health care community. The program encompassed a spectrum of issues that are particularly relevant to this debate, including models of care and participation in clinical trials, sexuality and fertility, self-esteem and other psychosocial dimensions, transitions of care, and health promotion. Importantly, there were discussions of interactions between teenagers with cancer and their health care providers, and of model support systems for this group of patients, with members of the survivor population contributing to both of these discussions. Since this event, interest in adolescent and young adult (AYA) oncology has expanded enormously. The AYA Committee of the Children's Oncology Group (COG) has flourished, the TCT has held 2 successful conferences, the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) has worked with the AYA committee of the COG to produce a monograph,4 and the Lance Armstrong Foundation has partnered with the NCI in an AYA Oncology Process Review Group. In addition, what to our knowledge is the first textbook to date dealing specifically with cancer in AYA patients is scheduled for publication by the September 2006 meeting of the International Society of Pediatric Oncology (SIOP) to be held in Geneva, at which time an International Working Group on AYA oncology will be convened. Although much remains to be accomplished in areas such as health insurance and access to care (including clinical trials) designed particularly for the AYA population, momentum has been gained, early strides have been made, and the future holds promise for notable advances in this endeavor to rise to the particular challenges faced by young people with malignant disease.