Download PDF
Klin Padiatr 2013; 225(06): 335-338
DOI: 10.1055/s-0033-1358663
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Adolescents and Young Adults (AYA) with Cancer in a Multidisciplinary Setting: On the Way to a Highly Specialized AYA Unit

Multidisziplinäre Behandlung von Jugendlichen und jungen Erwachsenen mit Krebs: Aufbau einer spezialisierten Abteilung für AYA mit Krebs
T. Bernig
2   Pediatric Oncology and Hematology, University Children’s Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
F. Jahn
1   Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
S. Witkowsky
2   Pediatric Oncology and Hematology, University Children’s Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
R. Huehn
2   Pediatric Oncology and Hematology, University Children’s Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
A. Hentschel
2   Pediatric Oncology and Hematology, University Children’s Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
T. Kegel
1   Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
H.-J. Schmoll
1   Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
,
D. Körholz
2   Pediatric Oncology and Hematology, University Children’s Hospital, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
28 October 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Further survival improvements of adolescents and young adults (AYA) with cancer are clearly affected by biological characteristics of the malignancies and age-specific needs. Multidisciplinary teams drawing expertice from both pediatric and adult cancer teams as well as clinical trials are required to meet the age specific needs of AYA patients with cancer. In 2011, the first AYA unit was established at the University Hospital Halle (Saale), where patients with newly-diagnosed cancer aged 15–25 are treated interdisciplinary by pediatric and adult oncologists. The enrollment into pediatric or adult clinical trials is controlled by age 18. Over the last 2 years, 19 AYA with cancer have been treated at the unit; and, in turn patients and their relatives reflected a high satisfaction with the offered novel health care approach. In the scope of the future Comprehensive Cancer Center at the University Hospital Halle (Saale), a complete ward is planned for all admitted AYA up to 25 years with cancer. The patients will be treated by a tumor-specialized multidisciplinary team of adult or pediatric oncologists and oncological surgeons. Therefore, we intend to establish a special teaching curriculum for physicians, nurses and psychosocial health care staff. Rather than age, cancer biology of a malignancy, surveillance data of late side effects as well as the age-specific needs of AYA patients will be crucial for best treatment options.

Zusammenfassung

Die Prognose von Jugendlichen und jungen Erwachsenen mit Krebs wird sowohl vom biologischen Verhalten der Krebserkrankungen in dieser Altersgruppe als auch durch altersspezifische psychosoziale Beonderheiten beeinflusst. Ein optimales Behandlungskonzept erfordert interdisziplinäre Behandlungsteams aus pädiatrischen und internistischen Onkologen sowie die Erarbeitung spezieller Behandlungsprotokolle für diese Patientengruppe. 2011 wurde am Universitätsklinikum Halle (Saale) die erste offizielle Behandlungseinheit für Jugendliche und junge Erwachsene (adolescents and young adults, AYA) im Alter von 15 bis 25 Jahren mit einer neu diagnostizierten Krebs­erkrankung etabliert, die interdisziplinär durch ein Team aus pädiatrischen und internistischen Onkologen behandelt werden. Hierbei entscheidet die Altergrenze von 18 Jahren über den Einschluss der Patienten in ein pädiatrisches oder internistisches Behandlungsprotokoll. Seit Start der AYA-Einheit wurden über 2 Jahre insgesamt 19 Jugendliche und junge Erwachsene mit Krebs behandelt. Sowohl die Patienten als auch ihre Angehörigen zeigten eine hohe Zufriedenheit über die neuartige Behandlungsstruktur. Im Rahmen der weiteren Entwicklung des Comprehensive Cancer Center am Universitätsklinikum Halle (Saale) ist der Ausbau der AYA-Einheit für alle neu eingewiesenen Krebspatienten in der Altergruppe 15–25 Jahre geplant, wobei chirur­gische Fachdisziplinen in das interdisziplinäre Behandlungs­konzept miteinbezogen werden sollen. Geplant ist zudem die Erarbeitung eines Curriculums als Basis für die Ausbildung von Ärzten, Pflegekräften und psychosozialen Mitarbeitern in den Therapiekonzepten für Jugendliche und junge Erwachsene mit Krebs. Zukünftig sollen das biologische Ver­halten der Malignome, mögliche therapiebedingte Spätfolgen bzw. altersbedingte psychosoziale Besonderheiten der AYA entscheidend für optimale Behandlungsstrategien sein.

Key words

adolescents and young adults - cancer - age-specific needs - tumor biology - late side-effects

Schlüsselwörter

Jugendliche und junge Erwachsene - Krebs - altersspezifische ­Besonderheiten - Tumorbiologie - Spätfolgen
 

  • References

  • 1 Birch RJ, Morris EJ, West RM et al. A cross-sectional survey of healthcare professionals to determine what they believe constitutes ‘specialist’ care for teenage and young adult patients with cancer. BMJ Open 2013; 3 DOI: 10.1136/bmjopen-2012-002346.
    PubMedGoogle Scholar
  • 2 Bleyer A, Barr R, Hayes-Lattin B et al. The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer 2008; 8: 288-298
    CrossrefPubMedGoogle Scholar
  • 3 Bleyer A, Choi M, Fuller CD et al. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol 2009; 36: 460-467
    CrossrefPubMedGoogle Scholar
  • 4 Boissel N, Auclerc MF, Lheritier V et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol 2003; 21: 774-780
    CrossrefPubMedGoogle Scholar
  • 5 Dieluweit U, Seitz DCM, Besier T et al. Utilization of psycosocial care and oncological follow-up assessments among German long-term survivors of cancer with onset during adolescence. Klin Padiatr 2011; 223: 152-158
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Eichenauer DA, Borchmann P, Engert A. Adolescents with Hodgkin lymphoma: old children or young adults?. Leuk Lymphoma 2012; 53: 1257-1262
    CrossrefPubMedGoogle Scholar
  • 7 Eichenauer DA, Bredenfeld H, Haverkamp H et al. Hodgkin’s lymphoma in adolescents treated with adult protocols: a report from the German Hodgkin study group. J Clin Oncol 2009; 27: 6079-6085
    CrossrefPubMedGoogle Scholar
  • 8 Ferrari A, Thomas D, Franklin AR et al. Starting an adolescent and young adult program: some success stories and some obstacles to overcome. J Clin Oncol 2010; 28: 4850-4857
    CrossrefPubMedGoogle Scholar
  • 9 Franklin J. Do children with Hodgkin’s disease have a better prognosis than adults? Application of a generalised linear model to a systematic review of published results. Stud Health Technol Inform 2000; 77: 18-22
    PubMedGoogle Scholar
  • 10 Freyer DR, Felgenhauer J, Perentesis J. Children’s Oncology Group’s 2013 blueprint for research: adolescent and young adult oncology. Pediatr Blood Cancer 2013; 60: 1055-1058
    CrossrefPubMedGoogle Scholar
  • 11 Gatta G, Zigon G, Capocaccia R et al. Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer 2009; 45: 992-1005
    CrossrefPubMedGoogle Scholar
  • 12 Göbel U, Creutzig U, Klingebiel T et al. Adolescents with cancer – administrative, clinical and scientific implications. Klin Padiatr 2011; 223: 311-314
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Grunewald TG, Greulich N, Kontny U et al. Targeted therapeutics in treatment of children and young adults with solid tumors: an expert survey and review of the literature. Klin Padiatr 2012; 224: 124-131
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Hayes-Lattin B, Mathews-Bradshaw B, Siegel S. Adolescent and young adult oncology training for health professionals: a position statement. J Clin Oncol 2010; 28: 4858-4861
    CrossrefPubMedGoogle Scholar
  • 15 Isakoff MS, Freyer DR, Bleyer A. Young adults with acute lymphoblastic leukemia treated with a pediatric-inspired regimen do not need a bone marrow transplant in first remission. Blood 2013; 121: 5253-5254
    CrossrefPubMedGoogle Scholar
  • 16 Kluge R, Körholz D. Role of FDG-PET in staging and therapy of children with Hodgkin lymphoma. Klin Padiatr 2011; 223: 315-319
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Martin S, Ulrich C, Munsell M et al. Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist 2007; 12: 816-824
    CrossrefPubMedGoogle Scholar
  • 18 Möricke A, Zimmermann M, Reiter A et al. Prognostic impactof age in children and adolescents with acute lymphoblastic leukemia: data from the trials ALL-BFM86, 90 and 95. Klin Padiatr 2005; 217: 310-320
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Mullighan CG, Willman CL. Advances in the Biology of Acute Lymphoblastic Leukemia – From Genomics to the Clinic. J Adolesc Young Adult Oncol 2011; 1: 77-86
    PubMedGoogle Scholar
  • 20 Palmer S, Patterson P, Thompson K. A national approach to improving adolescent and young adult (AYA) oncology psychosocial care: The development of AYA-specific psychosocial assessment and care tools. Palliat Support Care 2013; 1-6
    PubMedGoogle Scholar
  • 21 Schneider DT, Calaminus G, Koch S et al. Epidemiological analysis of 1,442 children and adolescents registered in the German Germ Cell Tumor Protocols. Pediatr Blood Cancer 2004; 42: 169-175
    CrossrefPubMedGoogle Scholar
  • 22 Schneider DT, Schuster AE, Fritsch MK et al. Genetic analysis of childhood germ cell tumors with comparative genomic hybridization. Klin Padiatr 2001; 213: 204-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Schreiber-Gollwitzer B, Gallo AD, Maier S. Position paper by the Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) and the Deutsche Leukämie-Forschungshilfe (DLFH) on psyco-social care for pediatric oncology and hematology patients in hospital. Klin Padiatr 2007; 219: 368-371
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Sender LS. A New Journal to Improve Care for Adolescent and Young Adult Oncology Patients and Survivors. J Adolesc Young Adult Oncol 2011; 1: 1-2
    PubMedGoogle Scholar
  • 25 Sender LS. What should the age range be for AYA oncology?. J Adolesc Young Adult Oncol 2011; 1: 3-10
    PubMedGoogle Scholar
  • 26 Shaw PH, Boyiadzis M, Tawbi H et al. Improved clinical trial enrollment in adolescent and young adult (AYA) oncology patients after the establishment of an AYA oncology program uniting pediatric and medical oncology divisions. Cancer 2012; 118: 3614-3617
    CrossrefPubMedGoogle Scholar
  • 27 Smith EC, Ziogas A, Anton-Culver H. Association between insurance and socioeconomic status and risk of advanced stage Hodgkin lymphoma in adolescents and young adults. Cancer 2012; 118: 6179-6187
    CrossrefPubMedGoogle Scholar
  • 28 Stock W, La M, Sanford B et al. What determines the outcomes for adolescents and young adults with acute lymphoblastic leukemia treated on cooperative group protocols? A comparison of Children’s Cancer Group and Cancer and Leukemia Group B studies. Blood 2008; 112: 1646-1654
    CrossrefPubMedGoogle Scholar
  • 29 Veneroni L, Mariani L, Lo VS et al. Symptom interval in pediatric patients with solid tumors: adolescents are at greater risk of late diagnosis. Pediatr Blood Cancer 2013; 60: 605-610
    CrossrefPubMedGoogle Scholar
  • 30 Wood WA, Lee SJ. Malignant hematologic diseases in adolescents and young adults. Blood 2011; 117: 5803-5815
    CrossrefPubMedGoogle Scholar
  • 31 Zebrack BJ, Block R, Hayes-Lattin B et al. Psychosocial service use and unmet need among recently diagnosed adolescent and young adult cancer patients. Cancer 2013; 119: 201-214
    CrossrefPubMedGoogle Scholar