Bleyer Archie
St. Charles Medical Center, 2500 NE Neff Rd., Bend, OR 97701, USA.
Pediatr Hematol Oncol. 2007 Jul-Aug;24(5):325-36. doi: 10.1080/08880010701316850.
Whereas adolescents with cancer as a group used to have a better prognosis than children with malignant disease, trends suggest that the overall survival of 15- to 19-year-olds is now worse than in younger patients. Also, the incidence of cancer is higher in 15- to 19-year age span than during the first 15 years of life. In 2006, the U.S. National Cancer Institute (NCI) and the Lance Armstrong Foundation conducted a Program Review Group (PRG) of the Adolescent and young Adult (AYA) problem. Recommendations covered awareness, prevention/cancer control/epidemiology/risk, biology, access, health insurance, clinical care models, clinical trials/research, special populations, psychosocial/behavioral factors, health-related quality of life, and long-term effects. This Commentary reviews each of the primary executive recommendations of the PRG report with respect to their adolescent oncology perspective and application. Primary implementation of the recommendations is responsibility of a new consortium of organizations devoted to assisting adolescents and young adults with cancer, the LiveStrong Young Adult Alliance, a program of the Lance Armstrong Foundation. Prior programs included the Children's Oncology Group AYA Committee and two disease-specific initiatives: the Intergroup Consortium Against Sarcoma and a clinical trial in young adults with acute lymphoblastic leukemia that will be conducted by Cancer and Leukemia Group B, the Southwest Oncology Group, and Eastern Cooperative Oncology Group. Preliminary evidence indicates that these efforts have already had measurable success.
以往，患癌青少年群体的预后通常优于患恶性疾病的儿童，但目前的趋势表明，15至19岁青少年的总体生存率现在低于年龄更小的患者。此外，15至19岁年龄段的癌症发病率高于生命的前15年。2006年，美国国家癌症研究所（NCI）和兰斯·阿姆斯特朗基金会针对青少年和青年成人（AYA）问题开展了一次项目审查小组（PRG）会议。建议涵盖了认知、预防/癌症控制/流行病学/风险、生物学、可及性、健康保险、临床护理模式、临床试验/研究、特殊人群、心理社会/行为因素、健康相关生活质量以及长期影响等方面。本述评从青少年肿瘤学的角度及应用方面，对PRG报告的每一项主要执行建议进行了审视。这些建议的主要实施工作由一个致力于帮助患癌青少年和青年成人的新组织联盟负责，即“坚强活下去青年成人联盟”，它是兰斯·阿姆斯特朗基金会的一个项目。之前的项目包括儿童肿瘤学组AYA委员会以及两项针对特定疾病的倡议：肉瘤国际协作组，以及一项针对急性淋巴细胞白血病青年成人患者的临床试验，该试验将由癌症与白血病B组、西南肿瘤学组以及东部肿瘤协作组共同开展。初步证据表明，这些努力已经取得了显著成效。
