Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Cancer. 2011 May 15;117(10 Suppl):2316-22. doi: 10.1002/cncr.26048.
The reduction in the cancer mortality rate in adolescents and young adults (AYA) with cancer has lagged behind the reduction noted in children and older adults. Studies investigating reasons for this are limited but causes appear to be multifactorial. Host factors such as developmental stage, compliance, and tolerance to therapy; provider factors such as lack of awareness of cancer in AYA and referral patterns; differences in disease biology and treatment strategies; low accrual onto clinical trials; and lack of psychosocial support and education programs for AYA all likely play a role. Recommendations for change from a recent international workshop include education of physicians and patients concerning AYA cancer, improved cooperation between pediatric and adult centers, age-appropriate psychosocial support services, programs to help AYA with issues relevant to them, dedicated AYA hospital space, improved accrual to clinical trials, the use of technology to educate patients and enhance communication between patients and the health care team, and ensuring that resident and fellowship training programs provide adequate education in AYA oncology. The longer term goal is to develop AYA oncology into a distinct subspecialist discipline within oncology. The ideal model of care would incorporate medical care, psychosocial support services, and a physical environment that are age-appropriate. When this is not feasible, the development of "virtual units" connecting patients to the health care team or a combination of physical and virtual models are alternative options. The assessment of outcome measures is necessary to determine whether the interventions implemented result in improved survival and better quality of life, and are cost-effective.
青少年和年轻成人（AYA）癌症患者的死亡率下降速度落后于儿童和老年患者。虽然有研究调查了导致这一现象的原因，但这些研究数量有限，而且原因似乎是多方面的。宿主因素，如发育阶段、依从性和对治疗的耐受性；提供者因素，如对 AYA 癌症的认识不足和转诊模式；疾病生物学和治疗策略的差异；临床试验的入组率低；以及缺乏针对 AYA 的社会心理支持和教育计划，这些都可能起到了一定作用。最近一次国际研讨会提出的变革建议包括：对医生和患者进行 AYA 癌症相关教育；改善儿科和成人中心之间的合作；提供适合年龄的社会心理支持服务；制定帮助 AYA 解决与自身相关问题的计划；设立专门的 AYA 医院空间；提高临床试验的入组率；利用技术对患者进行教育并加强患者与医疗团队之间的沟通；确保住院医师和研究员培训计划在 AYA 肿瘤学方面提供充分的教育。长期目标是将 AYA 肿瘤学发展成为肿瘤学中的一个独特亚专科。理想的护理模式将包含医疗护理、社会心理支持服务以及适合年龄的物理环境。当这不可行时，可以开发“虚拟单位”将患者与医疗团队联系起来，或者采用物理和虚拟模式相结合的方式。评估结果衡量标准对于确定所实施的干预措施是否能提高生存率和改善生活质量、是否具有成本效益是必要的。
