Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.
J Natl Compr Canc Netw. 2023 Aug;21(8):881-888. doi: 10.6004/jnccn.2023.7056.
Individuals diagnosed with cancer as adolescents and young adults (AYAs; ages 15-39 years) face unique vulnerabilities. Compared with individuals diagnosed when younger (≤14 years) or older (≥40 years), AYAs have not seen the same improvement in survival. Furthermore, they sit at a complex moment of social, emotional, and cognitive development, and have a unique interface with the healthcare system. With these observations, NCI prioritized addressing the unique vulnerabilities among AYAs with cancer, and NCCN developed guidelines regarding optimal AYA cancer care. Improvements in certain locales have been seen in the wake of this focus on AYAs, suggesting that continuing to consider AYA outcomes in the context of their specific needs is critical as we strive toward additional improvements. However, it is key to consider the drivers of these outcomes to continue this trajectory. This review presents a holistic conceptual model that includes factors that influence outcomes among AYAs with cancer, including domains in these levels that influence both clinical outcomes (such as relapse and survival) and health-related quality of life (HRQoL). These include domains at the patient level, such as social constructs (race/ethnicity, socioeconomic status), behavior (adherence, risk-taking), biologic characteristics (cancer biology, host genetics), medical treatment (treatment regimen, risk-based survivorship care), and treatment-related toxicities. The model also includes domains at the system level, which include treatment location (NCI designation, facility model, AYA program presence), clinical trial enrollment, transdisciplinary communication, fertility preservation, and psychosocial support. Recognizing these multiple factors at the level of the individual and the healthcare system influence AYA outcomes (from HRQoL to survival), it is key not only to consider patient-level interventions and development of novel cancer agents but also to develop systems-level interventions that can be executed in parallel. In this way, the impact can be expanded to a vast number of AYAs.
被诊断患有癌症的青少年和年轻成年人（AYAs；年龄 15-39 岁）面临着独特的脆弱性。与年轻时（≤14 岁）或年龄较大时（≥40 岁）被诊断出的患者相比，AYAs 的生存率没有同样的提高。此外，他们正处于社会、情感和认知发展的复杂时刻，与医疗保健系统有着独特的接口。鉴于这些观察结果，NCI 将解决患有癌症的 AYA 所面临的独特脆弱性作为优先事项，NCCN 制定了关于优化 AYA 癌症护理的指南。在这一重点关注 AYA 的背景下，某些地方的情况有所改善，这表明在努力取得进一步改善的过程中，必须根据他们的特定需求继续考虑 AYA 的结果。然而，关键是要考虑影响这些结果的因素，以继续保持这一趋势。本综述提出了一个全面的概念模型，其中包括影响患有癌症的 AYA 结果的因素，包括影响临床结果（如复发和生存）和健康相关生活质量（HRQoL）的这些水平上的领域。这些领域包括患者层面的社会结构（种族/民族、社会经济地位）、行为（依从性、冒险行为）、生物学特征（癌症生物学、宿主遗传学）、医疗治疗（治疗方案、基于风险的生存护理）和治疗相关毒性等。该模型还包括系统层面的领域，包括治疗地点（NCI 指定、医疗机构模式、AYA 项目存在）、临床试验参与、跨学科沟通、生育力保存和心理社会支持。认识到个体和医疗保健系统层面的这些多个因素会影响 AYA 的结果（从 HRQoL 到生存），不仅要考虑患者层面的干预措施和新型癌症药物的开发，还要开发可以并行执行的系统层面的干预措施，这样可以将影响扩大到大量的 AYA。
