发展科学方法在青少年和青年癌症研究中确定年龄亚组的应用。
A Developmental Science Approach to Informing Age Subgroups in Adolescent and Young Adult Cancer Research.
机构信息
Institute of Health System Science, Northwell Health, Manhasset, New York; Northwell Health Cancer Institute, Northwell Health, Manhasset, New York.
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington.
出版信息
J Adolesc Health. 2023 Sep;73(3):543-552. doi: 10.1016/j.jadohealth.2023.04.014. Epub 2023 Jun 8.
PURPOSE
Adolescent and young adult (AYA; diagnosed ages 15-39) cancer survivors are developmentally heterogenous, and this population consists of at least three distinct theoretically informed subgroups, as follows: adolescents, emerging adults, and young adults. However, there are limited evidence-based recommendations for delineating the validity of these subgroups in cancer-specific research. We sought to inform recommended chronological age ranges for each subgroup based on developmental processes.
METHODS
The data were collected using a 2x3 stratified sampling design (on-vs. off-treatment; ages 15-17, 18-25, 26-39) and a cross-sectional survey. AYAs (N = 572) completed three subscales of the Inventory of Dimensions of Emerging Adulthood (identity exploration, experimentation/possibilities, and other-focused), and we used regression tree analyses to identify distinct shifts in mean subscale scores that would indicate unique subgroups. Models included (a) chronological age, (b) chronological age + cancer-related variables, and (c) chronological age + sociodemographic/psychosocial variables as predictors of each developmental measure.
RESULTS
The recommended age ranges for AYA survivors receiving active treatment were consistent with prior research as follows: adolescents ages 15-17, emerging adults ages 18-24, and young adults ages 25-39. Models for off-treatment survivors suggested four distinct subgroups: adolescents ages 15-17, emerging adults ages 18-23, and 'younger' (ages 24-32) and 'older' young adults (ages 33-39). No sociodemographic or psychosocial variables meaningfully shifted these recommendations.
DISCUSSION
Our results suggest that three developmental subgroups remain appropriate for on-treatment survivors, but a second young adult subgroup (ages 33-39) emerged for off-treatment survivors. Therefore, development disruptions may be more likely to occur or manifest in post-treatment survivorship.
目的
青少年和年轻成年人（AYA；诊断年龄为 15-39 岁）癌症幸存者在发育上存在异质性，这一人群至少包括三个具有不同理论依据的亚组，如下所示：青少年、新兴成年人和年轻成年人。然而，在癌症特定研究中，对于这些亚组的有效性划分，目前仅有有限的基于证据的推荐意见。我们旨在根据发育过程为每个亚组提供建议的年龄范围。
方法
使用 2x3 分层抽样设计（治疗中与治疗后；年龄 15-17 岁、18-25 岁、26-39 岁）和横断面调查收集数据。AYA（N=572）完成了《新兴成年人维度清单》（身份探索、实验/可能性和以他人为中心）的三个分量表，我们使用回归树分析来确定表明独特亚组的平均分量表得分的显著变化。模型包括（a）年龄、（b）年龄+癌症相关变量和（c）年龄+社会人口学/心理变量作为每个发育指标的预测因子。
结果
接受积极治疗的 AYA 幸存者的建议年龄范围与先前的研究一致，如下所示：青少年为 15-17 岁，新兴成年人为 18-24 岁，年轻成年人为 25-39 岁。治疗后幸存者的模型则提示了四个不同的亚组：青少年为 15-17 岁，新兴成年人为 18-23 岁，以及“年轻”（年龄 24-32 岁）和“年长”的年轻成年人（年龄 33-39 岁）。没有社会人口学或心理变量显著改变了这些建议。
讨论
我们的结果表明，三个发育亚组仍然适用于治疗中的幸存者，但对于治疗后的幸存者，出现了第二个年轻成年人亚组（年龄 33-39 岁）。因此，在治疗后生存期间，发育中断可能更有可能发生或表现出来。
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