Abstract
Simple SummaryIt is unclear what the risk of negative health outcomes is after cancer during adolescence and young adulthood. We conducted a review to understand the risk of second cancers, chronic conditions, and death in adolescent and young adult (AYA) cancer survivors and found factors that increase the risk. In total, 652 studies were identified, of which 106 were included in the review: 23 for second cancers, 34 for chronic conditions, and 54 for deaths. The number of included studies increased over time, from four studies in 2010 to 17 in 2020. The studies found that AYA cancer survivors are at an increased risk of second cancers, chronic conditions, and deaths. In particular, the following factors increased risk: radiation exposure for second cancers; younger attained age and earlier calendar period of diagnosis for chronic conditions; and non-Hispanic Black or Hispanic, low socioeconomic status, and earlier calendar period of diagnosis for deaths.Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.
Highlights
An estimated 1.2 million adolescents and young adults (AYAs), aged 15–39 years, were diagnosed with cancer in 2020 globally [1,2]
Studies were deemed eligible for inclusion in the scoping review if they met the following criteria defined a priori: (1) The study participants included individuals with a history of cancer who were AYAs at the time of diagnosis, including studies not exclusively focused on AYAs (e.g., 0–19 year olds) if age-stratified results, which captured the AYA subgroup, were reported; (2) the study included one or more of the three outcomes defined above; (3) the research was a prospective or retrospective cohort study to allow the examination of the relationship between the AYA cancer exposure and the late effect; and (4) the study was original research published in English in the years 2010–2020
For AYA cancer survivors, the development of late effects after cancer can exacerbate the challenges of being a young person, such as balancing social relationships, new careers, and education with limited practical knowledge and financial resources [113,114]
Summary
An estimated 1.2 million adolescents and young adults (AYAs), aged 15–39 years, were diagnosed with cancer in 2020 globally [1,2]. The burden of late effects and their associated risk factors in AYA cancer survivors are not well understood. Several systematic reviews investigating late effects in survivors of childhood [5,6,7,8] and adult [9,10,11] cancers have been published recently, to our knowledge, only one systematic literature review investigating late effects among AYA cancer survivors has been published in the last decade, and that focused on the 16–29 year age range [12]. Given important social and biological differences of AYA cancer, a review of the current evidence on the relationship between tumor-, treatment-, and patient-related risk factors and common late effects in AYA cancer survivors is warranted
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