SOURCE: National Cancer Institute
Cancer Epidemiology In Older Adolescents And Young Adults 15 To 29 Years Of Age, Including Seer Incidence And Survival: 1975-2000
PERSONAL / PATIENT
Awareness is a primary goal. Older adolescents and young adults not only believe they are immune to the risks of disease and accident, they do not realize the risk of cancer is one in 210 for those between 15 and 29 years of age in the U.S. Overcoming ideation of invincibility will require local and national educational efforts. The importance of healthcare availability and healthcare insurance coverage will also need more emphasis, while the availability and goals of clinical trials will require particular attention. Moreover, the approaches used to educate and recruit adolescent and young adult cancer patients to clinical trials and translational research efforts will likely need to be quite different from those utilized for older adults.
FAMILY / COMMUNITY
Those who associate with older adolescents or young adults should be aware that cancer occurs in this age group and be able to advise and encourage a medical evaluation for symptoms and signs of malignant disease. This applies to family members, friends, neighbors, classmates, teachers, fellow employees, employers, and clergy.
Health professionals must become more aware of cancer occurring during early adulthood, and professional training and continuing education should emphasize the risk of cancer and its common symptoms and signs. Health professionals should become advocates for affordable health insurance. Oncologists should become more cognizant of the gaps in clinical trial activity and translational research in the adolescent and young adult group. They should make available more clinical trials for the adolescent and young adult population and seek ways to increase clinical trial participation specific to this age group.
SOCIETAL / CULTURAL
The lack of awareness of the adolescent and young adult cancer problem should be overcome with public information and education programs. Legislators, health policy administrators, insurance company directors, national medical organization leaders, and leaders of institutions of higher learning should be particularly informed and educated. The role of healthcare insurance should be emphasized, as should the risk of cancer in educational curricula. In the U.S., cancer organizations such as the American Society of Clinical Oncology, the American Cancer Society, the National Cancer Institute, the National Comprehensive Cancer Network, C-Change, and the national cancer cooperative groups should make adolescent and young adult oncology a priority. They should be joined in this effort by private cancer foundations that have a responsibility for young adults or older adolescents, such as Planet Cancer, Fertile Hope, Young Survival Coalition, and The Leukemia and Lymphoma Society (see Appendix I). Ideally, universal healthcare insurance should be available to all persons in the 18- to 29-year age range, until private insurance is provided by an employer or young people can afford or supplement it on their own.
IN SUMMARY, improving awareness of the cancer problem, providing better healthcare insurance coverage and access to healthcare services, and increasing clinical and translational research on cancer in older adolescents and young adults are challenges that would benefit patients in this age group. This is not to say that challenges such as psychosocial supportive care and dedicated healthcare facilities are not important. On the contrary, they are crucial. But tackling problems of highest priority is likely to have downstream effects that will alleviate many of the other problems listed in Table 15.1. The solutions will take a coordinated effort at local, regional, national and international levels.