Cancer in Adolescents and Young Adults

Adolescents and young adults aged 15 to 30 years have a statistically low rate of cancer (1 of every 168 US residents). This comprehensive book claims to be the first devoted exclusively to the total cancer picture of this targeted age set. It follows an earlier monograph and extensive review article.¹ The editors and authors are all well-known researchers in US and western European pediatric hematology-oncology.

The spectrum of cancers in persons aged 15 to 30 years is unique. Sarcomas, Hodgkin disease, male and female gonadal and nongonadal germ cell tumors, and oligodendroglioma are representative of cancers with peak incidence in this younger age group. Within this age span, variance also exists as a function of age. Cancers predominant in older adults as well as in young children are rarely seen in this specific demographic group. The age group in question has traditionally not been designated as part of the realm of either the pediatric or the adult oncologist. Demographics of practitioner availability, the type of disease, and the preferences of referring physicians as well as those of patients determine who provides care, whereas the background and certification of the consultant determines treatment.

Special and unique issues arise when a young adult presents with cancer, particularly a cancer more commonly treated by pediatric oncologists. The authors make compelling arguments for integrated strategies that allow young adults to benefit from the combined expertise of pediatric and adult oncologists in systems that identify both the complex disease and the social issues specific to this population. Treatment strategies in pediatric oncology rely heavily on the intensification of therapy permitted by this population's resilience and good organ function. Accordingly, protocols for pediatric patients often are much more intense than those designed for adults and geriatric patients. Pediatric clinical trials are more inclusive, possibly because they encourage broader entry criteria than the adult protocols and often do not exclude patients with comorbid conditions. The authors present information to demonstrate the superior results obtained through the pediatric oncology approach. Exceptions such as testicular cancer, for which adult oncologists have a long track record, are reviewed with a critique as to why the treatment regimens work.

The 15 most common categories of cancer are reviewed in a manner consistent with other texts. Specific protocols are not usually listed. The epidemiology, natural progressions of each malignancy, diagnostic approaches, and treatments are compared and contrasted with those for younger patients (birth through age 15 years) and with those older than 30 years. Strategies of early detection and prevention are given special attention. Issues of social support systems, insurance, and economic aspects of heath care (direct and indirect) are addressed. Although these patients do well, especially when compared with older adults, there has been a considerable lack of documented improvement: “There is no other patient age group for which the time period to diagnosis is longer, clinical trial participation is lower, and fewer specimens are available for translational research.” The shortcomings of the approaches to cancer in this age range are subsequently addressed in proposed model programs. The proposed models include relationships with other specialties that do not specifically target this age group, ie, infectious disease, pulmonary medicine, gastroenterology, thoracic and abdominal surgery, urology, otolaryngology, and neurosurgery. New patterns of communication are therefore advocated and endorsed as essential for productive interaction and exchange between these specialties.

Organization within this textbook is displayed in a consistent format. References are extensive and oriented to pediatric hematology-oncology authors. The appendix includes some Internet references for foundations but none for updates. The 77 contributing authors are primarily from the United States, with some United Kingdom, other European, and Israeli participation. Conclusions from each chapter propose improvements through the theme of clinical trials. With that background, there is a proposed need for an improved classification system relative to adolescents and young adults. Present systems are shown to lack applicability to the focus group. A morphologic scheme now used in England and Wales is insightfully proposed.

This book serves multiple purposes and should be available to those treating its target population. While presenting a straightforward analysis, the authors make a continuous effort to emphasize the special nature of the target group. They do not make this case for radiation oncology or surgery but only for medicine, pediatrics, and ephebiatrics. Accordingly, the conclusions of the book do have implications for national policy regarding insurance, employment, and the US educational system.

The National Cancer Institute has proactively established a “Progress Review Group to identify and prioritize scientific medical and social goals facing the target group.” Part of the evaluation is aimed to increase participation in clinical trials, and “The ultimate goal is to heighten awareness of a relatively neglected group.”