The 4YouLab Model: A Dedicated-Program for Adolescents and Young Adults With Cancer in a Children's Hospital.

Abstract

Recently, there has been a growing attention to patients defined by the acronym AYA (adolescents and young adults). Therapeutic strategies and management protocols were developed to recognize the specific psychosocial needs of this age group (1, 2). A cancer diagnosis places the patients at risk of adaptation disorders and anxiety-depressive syndromes due to emotionally and psychologically impacting effects (3). The effects can be more severe in adolescents (4). The disease and its treatment could compromise adolescent developmental paths: the construction and affirmation of the identity, the autonomy development, and the independence from the family unit (5, 6). Currently, the patients who need to be treated go beyond the oncological cure, utilizing a biopsychosocial approach involving the patients’ personal and social norms. One of the strategies for a specific professional care in the multidisciplinary team is to ensure an adequate quality of life during hospitalization (6). From this point of view, it is essential to support discussion and aggregation with other adolescents in the hospital setting, reduce isolation, and encourage emotional sharing and expression. By organizing moments for aggregation, sharing is encouraged between patients, which is helpful to the patients’ well-being and quality of life during treatment. The AYA cancer team utilizes a multidisciplinary care model focused on providing each patient with a holistic and tailored approach including social support together with the best cancer treatments. This approach is more attentive to quality of life and encourages the peer support group to “engage in conversation about having cancer with each other (7, 8). It is necessary to have an approach that includes both patient and caregiver needs in order to support AYA patients (9). Since there is no reproducible AYA program, each pediatric or adult center should create and adapt a dedicated program according to structural and economic resources (5, 10). Even in Italy, the effort of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) was oriented to the break down AYA’s poor access to pediatric referral centers and their poor inclusion in clinical trials that caused limited improved survival compared to different age patients (11, 12). Some centers in Italy were pioneers of the AYA-dedicated program, such as the Youth Area in Aviano and the Youth Project in Milan (13), set in two large adult National Cancer Institutes. In this paper, we discuss how we created an AYA program in a children’s hospital.