School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, California, USA.
School of Medicine, University of California Irvine, Irvine, California, USA.
Cancer Med. 2023 Nov;12(22):20953-20963. doi: 10.1002/cam4.6641. Epub 2023 Oct 30.
About 4.5% of new cancer cases affect adolescent and young adult aged between 15 and 39 years in the United States (US). However, the effect of neuropsychiatric conditions on long-term adolescent and young adult cancer (AYAC) survivors has not been formally investigated. Thus, the impact and management of late neuropsychiatric complications in AYAC survivors compared to non-cancer-matched controls (NCMC) in the US were evaluated using the All of Us (AoU) Research Program.
Participants in the AoU Controlled Tier Dataset (v6) diagnosed with cancer between ages 15 and 39 were identified from electronic health records and surveys. AYAC survivors were matched with NCMC using the optimal pair-matching algorithm at a 1:4 ratio. Data on past diagnoses, current follow-up care, and treatment patterns of neuropsychiatric complications were collected.
Analysis was performed on 788 AYAC survivors and 3152 NCMC. AYAC survivors, with an average of 8.8 years since their first cancer diagnosis, were more likely than NCMC to receive a diagnosis of neuropathy, memory loss and epilepsy (p < 0.001). Survivors also had a higher rate of follow-up care and treatment utilization for these neurological conditions compared to NCMC (p < 0.05). Treatment utilization was highest among survivors receiving care for epilepsy (88%), and lower for neuropathy (70%), memory loss (61%), and chronic fatigue (59%).
This large study reveals that AYAC survivors, on average 9 years after their cancer diagnosis, require more frequent follow-up care for neurological complications compared to non-cancer individuals. However, the management of neuropathy, memory loss, and chronic fatigue is hindered by a lack of mechanism-based effective therapies.
在美国，约有 4.5%的新发癌症病例影响 15 至 39 岁的青少年和青年。然而，神经精神疾病对长期青少年和青年癌症（AYAC）幸存者的影响尚未得到正式研究。因此，使用美国的 All of Us（AoU）研究计划评估了与非癌症匹配对照（NCMC）相比，AYAC 幸存者中晚期神经精神并发症的影响和管理。
从电子健康记录和调查中确定了 AoU 受控层数据集（v6）中年龄在 15 至 39 岁之间被诊断患有癌症的参与者。使用最佳配对匹配算法以 1:4 的比例将 AYAC 幸存者与 NCMC 匹配。收集了过去诊断，当前随访护理和神经精神并发症治疗模式的数据。
对 788 名 AYAC 幸存者和 3152 名 NCMC 进行了分析。AYAC 幸存者在其首次癌症诊断后平均有 8.8 年的时间，比 NCMC 更有可能被诊断出患有神经病，记忆力减退和癫痫（p<0.001）。与 NCMC 相比，幸存者的这些神经系统疾病的随访护理和治疗利用率也更高（p<0.05）。接受癫痫治疗的幸存者的治疗利用率最高（88％），而神经病（70％），记忆力减退（61％）和慢性疲劳（59％）则较低。
这项大型研究表明，AYAC 幸存者在癌症诊断后平均 9 年，需要更频繁地进行神经并发症的随访护理，而不是非癌症个体。但是，由于缺乏基于机制的有效治疗方法，神经病，记忆力减退和慢性疲劳的管理受到阻碍。
