Adolescents and young adults who fall ill with cancer have specific needs that are often neglected, both in terms of therapies and in terms of specialists and the departments in which they must be treated. The numbers also demonstrate this: teenagers and under 40s are, in fact, less likely to recover than children and adults, as various researches have shown. Differences in survival between age groups are due to a number of factors, including delays in diagnosis and initiation of care, lack of specific care guidelines, and lack of specific trials for 15-39 year olds. , as well as diversity related to the biology of the types of cancer that affect them. To fill the gaps and raise awareness on the problems of this category of patients, the European Society of Medical Oncology (Esmo, European Society for Medical Oncologists) and that of Pediatric Oncology (Siope, Society for Pediatric Oncology) have launched a document with the intent on improving anti-cancer treatments in this age group.

Time lost before diagnosis

At the heart of the position paper, just published in the scientific journal Esmo Open, is the urgent need to create targeted structures with professionals specialized in the diagnosis and treatment of cancers that affect young people between 15 and 39 years of age. It is well known that there are large inequalities in access to cancer treatment for AYA patients (from English Adolescents and Young Adults, i.e. adolescents and young adults) and that there is a lack of specialists and structures focused on their needs and specialized in the treatment of the neoplasms that affect them – underlines Andrea Ferrari, principal author of the document and co-coordinator of the Esmo-Siope AYA Working Group -. As a result, survival rates in recent years have improved less than those of adults and children. The objective of this position paper is therefore to make the problems and possible solutions better known.Every year there are over 150 thousand in Europe and 1.2 million in the world the new cases of cancer diagnosed in this age range, which represent approximately 7% of all new annual diagnoses.A first problem to be addressed is certainly the diagnostic delay, also due to the fact that tumors in young people are rare events and often those directly affected are the first to neglect the symptoms, then the patients lose precious months in visits and examinations before obtaining a correct diagnosis, because doctors themselves struggle to recognize an infrequent disease, with which they have to deal only a few times in the course of their professional career.

The particularities of tumors in this age group

It also takes time to find the right center in which to be treated: the possibilities of treatment and healing are often the same as those of other forms of cancer, but it is essential to rely on experienced doctors in the choice and management of therapies. Adolescents and young adults represent a unique group that lives in a middle ground between the world of pediatric oncology and that of adults and their management is still a challenge – continues Andrea Ferrari, oncologist of Pediatrics at the National Cancer Institute of Milan – . In AYA patients, both pediatric cancers and more typical adult cancers may arise, and there is limited awareness of the biological and clinical characteristics of these cancers and the specific needs of patients in both the general population and the medical-scientific community. A crucial aspect, among these, is related to the problem of access to the best treatments and clinical protocols, which determines a critical impact on therapeutic results and therefore on the probabilities of cure. Finally, it is essential to take into account the lives of our patients, the psychosocial sphere which is so specific and so complex. In short, more experiments and specific treatments, specially designed for younger patients, are needed. Too strict age limits to access scientific studies mean that the vast majority of studies on experimental drugs are dedicated to adult patients, who in fact have greater chances of recovery than the 15-39 year olds. The European position paper highlights the key challenges assistance to adolescent and young adult patients, such as the limited availability of specialized centers with age-appropriate multidisciplinary care.

Improve care

Improving awareness about the characteristics and needs of AYA patients is the central theme of the document – adds Ferrari -. One thing that goes hand in hand with the need to plan specific training for doctors, nurses and psychologists. Only in this way will it be possible to design dedicated specialized networks that are effective in responding to their real needs. In order to guarantee more and more specialized treatment paths in this group of patients, in our country the Italian Association of Medical Oncology (Aiom) and the Italian Association of Pediatric Hematology and Oncology (Aieop) have decided to join forces and give life to an inter-company group that follows the experience already started at an international level by Esmo and Siope. On the model of the European path, we want to give life to a project that involves not only doctors, but also psychologists and nurses and all the possible figures or structures involved – says Paola Quarello, pediatric oncologist at the Regina Margherita Hospital in Turin, member of the newborn group intercompany Aiom-Aieop -. As well as institutions and associations, including certainly the Italian Federation of Pediatric Oncohematology Parent Associations (Fiagop) and above all the patients themselves. It is fundamental to give a voice to them directly.The Italian working group was born above all with the aim of dissemination and education: The challenge certainly is to improve patient care – adds Fedro Peccatori, of the European Oncological Institute, involved by Aiom – . We want to define the minimum essential requirements that a center must have to deal with AYA patients: multidisciplinary groups involving pediatric and adult oncologists, flexible age limits for access to departments, clinical trials for different pathologies, fertility conservation projects , age-specific psychological and social support projects. We strongly believe in this initiative: the Aiom-Aieop work table will give new impetus to the management of cancer patients who will be able to make use of the specific skills of the professionals of the two scientific societies, concludes Saverio Cinieri, Aiom president-elect.

April 9, 2021 (change April 9, 2021 | 12:05)

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