AYA oncology

  • 文章类型: Journal Article
    本评论重点介绍了瑞士法律要求为人父母的青少年和年轻人(AYA)所面临的挑战和可能性。瑞士对生殖医学程序的监管比其他一些国家更严格。健康保险是强制性的,但是所涵盖的干预措施不断变化。最近的变化与未来的AYA父母身份的可能性有关,即使对卫生专业人员来说,跟上实际和法律后果的最新情况也是征税的。AYA面临的治疗决定是独特的脆弱性和依赖于全面的,clear,电流,以及与生育率有关的风险和选择的特定国家信息。本评论简要概述了瑞士与生殖医学有关的法律框架,强调其准入限制和禁令,以及最近的变化。虽然病人的重要性,同行,看护人,许多国家早已认识到支持受健康状况影响的人的利益集团,一个AYA组织最近才在瑞士成立。这些组织对于提供准确的,特定国家的信息和支持,在个性化医疗指导的同时,根据最新的法律框架及其后果,在解决与想要孩子有关的特定需求方面,仍然至关重要。
    This commentary focuses on the challenges and possibilities that adolescents and young adults with cancer (AYA) desiring parenthood face under Swiss law. The regulation of reproductive medicine procedures is stricter in Switzerland than in some other countries. Health insurance is compulsory, but the interventions that are covered are in constant flux. Recent changes pertain to the possibilities of future AYA parenthood and keeping up to date with practical and legal ramifications is taxing even for health professionals. AYA facing treatment decisions are uniquely vulnerable and dependent on comprehensive, clear, current, and country-specific information regarding risks and options pertaining to their fertility. This commentary provides a short overview of the Swiss legal framework related to reproductive medicine, highlighting its access restrictions and prohibitions, as well as recent changes. While the importance of patient, peer, caregiver, and interest groups supporting people affected by health conditions has long been recognized in many countries, an AYA organization was only recently established in Switzerland. Such organizations are vital for providing accurate, country-specific information and support, while individualized medical guidance, informed by the most current legal framework and its consequences, remains essential in addressing AYAs\' specific needs in connection with the desire to have children.
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  • 文章类型: Journal Article
    目的:每年,近100,000名青少年和年轻人(15-39岁,AYAs)在美国被诊断出患有癌症,许多人的身体状况未得到满足,社会心理,以及癌症治疗期间和之后的实际需求。为了响应改善该人群癌症护理服务的需求,全国各地出现了专门的AYA癌症项目。然而,癌症中心在制定和实施AYA癌症计划方面面临多层次的障碍,并且将受益于有关如何进行AYA计划开发的更强有力的指导。方法:为促进本指导,我们描述了北卡罗来纳大学(UNC)Lineberger综合癌症中心AYA癌症项目的发展。结果:我们总结了UNC的AYA癌症计划自2015年成立以来的演变,为发展提供了务实的策略,实施,并维持AYA癌症计划。结论:自2015年以来,UNCAYA癌症计划的发展产生了许多经验教训,我们希望这些经验教训可以为寻求为AYA建立专门服务的其他癌症中心提供信息。
    Purpose: Every year, nearly 100,000 adolescents and young adults (15-39 years, AYAs) are diagnosed with cancer in the United States and many have unmet physical, psychosocial, and practical needs during and after cancer treatment. In response to demands for improved cancer care delivery for this population, specialized AYA cancer programs have emerged across the country. However, cancer centers face multilevel barriers to developing and implementing AYA cancer programs and would benefit from more robust guidance on how to approach AYA program development. Methods: To contribute to this guidance, we describe the development of an AYA cancer program at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center. Results: We summarize the evolution of UNC\'s AYA Cancer Program since it was established in 2015, offering pragmatic strategies for developing, implementing, and sustaining AYA cancer programs. Conclusion: The development of the UNC AYA Cancer Program since 2015 has generated many lessons learned that we hope may be informative to other cancer centers seeking to build specialized services for AYAs.
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  • 文章类型: Journal Article
    背景:我们旨在分析西班牙青少年和年轻人肉瘤(AYA)的医疗保健服务。
    方法:向所有西班牙癌症中心发送了一项调查,包括关于人口统计的问题,设施,以及过去两年中AYAs与肉瘤的治疗策略。
    结果:35个单位参加了调查,17个儿科和15个成人单位。有三个专门的AYA单位。一线方案取决于治疗单位是否为儿科,对于骨肉瘤,横纹肌肉瘤,和非横纹肌肉瘤。相比之下,91.4%的尤因肉瘤按照EE2012进行治疗。在复发环境中,在所有肿瘤中,单位之间的差异更大。此外,48%的单位报告没有对该人群进行试验。
    结论:成人单位和儿科单位在AYAs与肉瘤的治疗上存在主要差异。需要付出巨大的努力来使治疗均匀化并增加获得创新的机会。
    BACKGROUND: We aimed to analyse health care services for adolescents and young adults (AYA) with sarcomas in Spain.
    METHODS: A survey was sent to all Spanish cancer centres, including questions about demographic, facilities, and treatment strategies for AYAs with sarcomas in the last 2 years.
    RESULTS: Thirty-five units participated in the survey, 17 paediatric and 15 adult units. There were three specialized AYA units. First line regimen varied depending on whether the treating unit was paediatric or not, for osteosarcomas, rhabdomyosarcomas, and non-rhabdomyosarcomas. By contrast, 91.4% of Ewing sarcomas were treated according to EE2012. In the relapse setting, differences between units were higher in all tumours. Additionally, 48% of the units reported not having trials for this population.
    CONCLUSIONS: There are major differences in the treatment of AYAs with sarcomas between adult and paediatric units. Enormous efforts are needed to homogenize treatments and increase the access to innovation.
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  • 文章类型: Journal Article
    Survival for childhood cancers has improved significantly over the last decades. However, patient outcomes have plateaued over the last decade for difficult-to-treat diseases. With high cure rates, decreasing long-term toxicities and sequelae remains crucial. Since many advances in childhood cancer research come from the adult oncology world, one of the key areas is improving the adaptation of tools that are essential for clinical trial conduct that were developed for adults into pediatrics. These include tools to evaluate toxicity, quality of life, radiological response, statistical methodology, or indicators of cancer care quality. In this review, we present ongoing international efforts to validate and adapt these tools for children and adolescents and discuss remaining challenges. These efforts will hopefully accelerate and improve the quality of pediatric oncology research in the upcoming years.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    OBJECTIVE: To examine whether the rates of thrombosis in children (≤14 years of age) and adolescent/young adult (AYA) patients (15-22 years of age) with cancer is different.
    METHODS: We retrospectively studied the rates of thrombosis in children and AYA patients at the Children\'s Hospital of Pittsburgh during the years 2002-2010, using the tumor registry database. This list was then divided into two groups based on age at diagnosis. A review of ICD-9 codes from hospital billing records was then performed to identify patients who carried diagnoses of cancer (140.x-239.x) and venous thrombosis of the extremities/vena cavae (453.x) simultaneously. This list was confirmed by electronic medical record review. Proportions, comparisons, and descriptive statistics were then performed.
    RESULTS: One thousand three hundred nine total patients were identified; 274 patients fit into the AYA age category (mean age 17.3 years) and 1036 patients were in the child group (mean age 6.5 years). Overall, 30 patients (2.29%) had thrombosis: 4.76% of the AYA patients (13/273) and 1.64% of the child group (17/1036). The difference in these proportions had a p-value = 0.004.
    CONCLUSIONS: This study suggests that the risk of extremity deep vein thrombosis is higher in the AYA subset of oncology patients than in the patients who are 14 years or younger. Prospective studies to elucidate the true rate of thrombosis, as well as to study the benefit of prophylactic anticoagulation in the AYA population, should be undertaken.
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  • 文章类型: Comparative Study
    背景:生育问题已被发现是青少年和年轻人(AYAs)患有癌症的重要话题。医疗技术使生育能力保留(FP)对于青春期后患者越来越有效,这些患者的治疗过程可能会抑制他们未来实现生物学父母的能力。肿瘤学提供者的建议已被证明是不同的,可能影响患者关于FP的决策过程。
    目的:本研究旨在评估肿瘤科护士对患者考虑FP选项的建议,并探讨哪些患者相关因素可能会影响FP与AYAs与癌症的讨论。
    方法:116名肿瘤科护士参与了这项研究,并随机阅读了关于一名患者的四个小插曲之一,该患者的拟议治疗过程可能会影响其生育能力。分析了参与者参与FP的建议,以测试患者年龄和性别的差异。对有关他们作为肿瘤科护士的经历的问题的开放式回答进行了描述性分析。
    结果:护士强烈建议所有患者在开始治疗前探索FP选项。肿瘤科护士赞同更强烈的意见,即年轻的成年女性患者应获得独立的决策权,以延迟FP的治疗。与男性和女性青少年患者和年轻成年男性患者相比。与会者提到了讨论的障碍,其中包括对加剧负面情绪和年轻患者决策能力的担忧。
    BACKGROUND: Fertility issues have been found to be an important topic for adolescents and young adults (AYAs) with cancer. Medical technology has made fertility preservation (FP) increasingly effective for postpubertal patients whose treatment course may inhibit their future ability to achieve biologic parenthood. Oncology providers\' recommendations have been shown to vary, potentially affecting patients\' decision-making processes regarding FP.
    OBJECTIVE: This study was designed to assess oncology nurses\' recommendations for patients to consider FP options and to explore what patient-related factors may influence discussion of FP with AYAs with cancer.
    METHODS: 116 oncology nurses participated in this study and were randomized to read one of four vignettes about a patient whose proposed treatment course could affect his or her fertility. Participants\' recommendations to partake in FP were analyzed to test for differences by patient age and gender. Open-ended responses to questions about their experiences as oncology nurses were analyzed descriptively.
    RESULTS: Nurses strongly recommended that all patients explore FP options before the start of treatment. Oncology nurses endorsed stronger opinions that young adult female patients should be given independent decision-making power to delay treatment for FP, compared to male and female adolescent patients and young adult male patients. Participants mentioned barriers to discussions that included concerns about exacerbating negative emotions and the decision-making capacity of young patients.
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  • 文章类型: Journal Article
    Overall cancer cure rates have risen over the last 30 years. Adolescent and young adult (AYA) oncology patients aged 15 to 39 have not shared in these successes as an age group, including those who fall into the younger age group of 15 to 19 years. The reasons for this deficit in survival improvement are manifold, but research has shown that an important factor is decreased enrollment in therapeutic clinical trials in this population versus younger patients. The paucity of adolescents treated in clinical trials is itself the result of several elements of the health care landscape in the United States. On the local level, these factors include referral patterns and facilities available; on the national level, related factors include the number of clinical trials available for this age group and health care provider education in the care of these patients. We examine the data available that have contributed to this deficit in the United States and offer broad strategies to address these shortcomings with the goal of improving outcomes in this underserved population.
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  • 文章类型: Journal Article
    Tremendous strides have been made in improving the outcomes of haematological malignancies (HM) over the last three decades, but adolescents and young adult (AYA) patients have not benefitted equally compared to younger and older patients. Excellent outcomes in Hodgkin lymphoma have allowed tailoring of highly effective regimens that limit the incidence of late effects. Early successes in paediatric acute lymphoblastic leukaemia set the stage for a series of studies in young adults utilizing a paediatric-type treatment strategy. These studies have determined that AYAs benefit from paediatric-type chemotherapy regimens. Despite the increased incidence of acute myeloid leukaemia and non-Hodgkin lymphoma in the AYA age group, optimal strategies for these patients have not been systematically pursued. There is renewed interest in improving HM outcomes in AYA patients and this will rely on the development of clinical trials that specifically target these patients. Understanding and addressing the unique psychosocial challenges of this population will be critical in supporting this endeavor.
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