Abstract
BackgroundThe present study aimed to assess whether the widespread concern of inferior cancer survival in adolescents and young adults (AYAs) compared with children and adults holds true in a Nordic setting with important differences in healthcare organisation compared with the United States (e.g. free access to healthcare) and the United Kingdom (e.g. young teenagers are treated in paediatric departments).MethodsFive-year relative survival was calculated for 17 diagnostic groups in patients diagnosed in 2000–2013 in three diagnostic age categories: children (0–14 years), AYAs (15–24 years) and adults (25–34 years).ResultsFor 13 out of 17 diagnostic groups examined, there was no difference in survival between AYAs and neighbouring age categories. For acute lymphoblastic leukaemias, astrocytomas, rhabdomyosarcomas and non-rhabdomyosarcoma soft tissue sarcomas we found survival in children to be superior to that in AYAs. For these four diagnostic groups, the rate of survival improvement over three calendar periods (1980–1989, 1990–1999 and 2000–2013) was not particularly low in AYAs compared with neighbouring age categories.ConclusionsThe present study suggests that in an affluent setting with free access to healthcare, meaningful differences in survival between AYA patients and either childhood or adult patients are a phenomenon of the past for most AYA cancer diagnostic groups.
Highlights
The present study aimed to assess whether the widespread concern of inferior cancer survival in adolescents and young adults (AYAs) compared with children and adults holds true in a Nordic setting with important differences in healthcare organisation compared with the United States and the United Kingdom
Recent studies from the United States and United Kingdom have indicated that survival of AYA cancer patients may be inferior to that of children with the same disease,[2,3,4] and that the improvement in treatment outcome achieved for children with cancer in recent decades is not visible in AYA patients.[2]
Survival compared with children and adults apply to the Nordic setting with important differences in healthcare organisation compared with the United States and the United Kingdom.[2,15]
Summary
The present study aimed to assess whether the widespread concern of inferior cancer survival in adolescents and young adults (AYAs) compared with children and adults holds true in a Nordic setting with important differences in healthcare organisation compared with the United States (e.g. free access to healthcare) and the United Kingdom (e.g. young teenagers are treated in paediatric departments). Cancers in AYA are mostly of the same types as those occurring in younger age groups, early-onset adult cancers are seen, e.g. some carcinomas.[2] recent studies from the United States and United Kingdom have indicated that survival of AYA cancer patients may be inferior to that of children with the same disease,[2,3,4] and that the improvement in treatment outcome achieved for children with cancer in recent decades is not visible in AYA patients.[2]. The prospect of AYA patients being disadvantaged with respect to survival and other quality-of-life indicators has spurred a search for both explanations and solutions on top of statistics characterising the problem.[3,5] Explanations include (1) that the age group lies in the traditional organisational divide between paediatric and adult oncology departments and that their treatment is not standardised,[5,6] (2) that the needs of AYA cancer patients differ physiologically (puberty) and psychologically from both children and older patients,[7] (3) that AYA cancer patients may experience longer diagnostic delays due to misinterpretation of symptoms by both the patients themselves and by healthcare professionals[7] and (4) that the AYA group as such is less inclined to participate in and comply with clinical trials than other age groups, leading to slower and less successful development of new treatments.[3,4,8,9,10,11,12] Attempted solutions include (1) specialised care for the AYA patient group,[7] (2) more collaboration among paediatric haematologists/oncologists and adult haematologists/oncologists to make common treatment guidelines and protocols,[3] (3) expanding the age range of paediatric treatment protocols, as it seems to increase survival for the AYA group to be treated according to these[13,14] and (4) new work packages aimed at AYAs.[9]
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