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Young Adult Oncology

The Patients and Their Survival Challenges

Dr. Bleyer is Adolescent and Young Adult Oncologist and Medical Advisor, Cancer Treatment Center, St. Charles Medical Center, Bend, OR; Adolescent and Young Adult Oncologist, Oregon Health and Sciences University, Portland, OR; and Director, CureSearch/National Childhood Cancer Foundation, Bethesda, MD, and Arcadia, CA.

This article is available online at http://CAonline.AmCancerSoc.org
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Disclosures: This review was supported by the Aflac Insurance Co. and NCI U10 Grant CA98543.

One in every 168 Americans develops invasive cancer between age 15 to 30 years. During this age interval, cancer is unique in the distribution of types that occur and rarely related to either environmental carcinogens, a recognizable inherited predisposition, or a family cancer syndrome. Patients in this age group have the lowest rate of health insurance coverage, frequent delays in diagnosis, and the lowest accrual to clinical trials. Their psychosocial needs are unique and generally less well attended to than in any other age group. Despite an intrinsically equal ability to tolerate chemotherapy, older adolescents and young adults frequently receive lower dose intensities than do younger patients, and at times less than in older patients. Whereas the 15- to 29-year age group once had a better overall survival rate than either younger or older patients, a relative lack of progress has resulted in the majority of cancers in the age group having a worse overall survival rate than in younger patients, and several of these having a worse prognosis than in older patients. Against this background, young adults with cancer have unique survival challenges—medically, psychosocially, and economically—that are now beginning to be appreciated and addressed with a national initiative.