Canadian adolescents and young adults with cancer: opportunity to improve coordination and level of care

Cancers in adolescents and young adults (aged 15-29 years) represent a transition between the nonepithelial types, especially acute leukemias and embryonal tumours, that are common during childhood and the epithelial types (i.e., carcinomas) that account for most cancers in older adults. The embryonal tumours that are common in children, such as neuroblastoma, Wilms tumour, retinoblastoma, medulloblastoma and hepatoblastoma, are rare among adolescents and young adults. Similarly, the most common carcinomas in older adults, such as lung, breast, prostate and colorectal cancers, have a much lower incidence among young people. The differences relative to other age groups is such that the classification system used to report cancer incidence in adolescents and young adults is a blend of those used for cancers in childhood and adult life.1 We estimated the five-year observed survival for Canadian adolescents and young adults aged 15 to 29 years at the time of cancer diagnosis at 85% for the period 2001-2005. Overall five-year observed survival for Europeans aged 15 to 24 years at diagnosis for the period 1995-2002 was recently reported as 87%, ranging from 84% in Northern Ireland to 92% in Italy.19 Both the Canadian and European studies showed improvements in survival over recent years. In the United States, the Surveillance, Epidemiology and End Results Program of the National Cancer Institute found improvements in survival over a longer period (1975-2000) for those 15 to 29 years of age.13 In some regions of the world, researchers have suspected that improvements in survival among adolescents and young adults are linked to medical insurance and treatment adherence, such that smaller improvements may be attributable to a lack of insured medical care and low compliance with treatment.20,21 Finally, Canadian, US and European data all indicate that survival is generally better for young females than young males, which could be related to the distribution of cancer types between the sexes.13,19 This lack of participation in clinical trials has been attributed to a variety of factors. For example, there is a paucity of suitable trials for the forms of cancer that commonly occur in adolescents and young adults, and adequate sample sizes must be accrued to achieve statistical power. In addition, adolescents and young adults may be less inclined to participate in a clinical trial, even if such an opportunity is offered. Clinicians and patients may not be aware of oppo