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New expectations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "221" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "David Gómez-Almaguer" "autores" => array:1 [ 0 => array:2 [ "nombre" => "David" "apellidos" => "Gómez-Almaguer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1665579614676099?idApp=UINPBA00004N" "url" => "/16655796/0000001600000065/v0_201607061452/X1665579614676099/v0_201607061453/en/main.assets" ] "itemAnterior" => array:15 [ "pii" => "X1665579614676072" "issn" => "16655796" "estado" => "S300" "fechaPublicacion" => "2014-10-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Medicina Universitaria. 2014;16:207-15" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3073 "formatos" => array:3 [ "EPUB" => 46 "HTML" => 2326 "PDF" => 701 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Ebola virus disease 2014" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "207" "paginaFinal" => "215" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "304v16n65-90367607fig2.jpg" "Alto" => 2004 "Ancho" => 1491 "Tamanyo" => 567862 ] ] "descripcion" => array:1 [ "en" => "Algorithm for Evaluation of the Returned Traveler." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kame Galán-Huerta, Daniel Arellanos-Soto, Ana María Rivas-Estilla, Verónica Bravo-de la Cruza, Javier Ramos-Jiménez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Kame" "apellidos" => "Galán-Huerta" ] 1 => array:2 [ "nombre" => "Daniel" "apellidos" => "Arellanos-Soto" ] 2 => array:2 [ "nombre" => "Ana María" "apellidos" => "Rivas-Estilla" ] 3 => array:2 [ "nombre" => "Verónica" "apellidos" => "Bravo-de la Cruza" ] 4 => array:2 [ "nombre" => "Javier" "apellidos" => "Ramos-Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X1665579614676072?idApp=UINPBA00004N" "url" => "/16655796/0000001600000065/v0_201607061452/X1665579614676072/v0_201607061453/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Adolescent and young adult (AYA) oncology — An emerging discipline" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "216" "paginaFinal" => "218" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ronald D. Barr" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Ronald D." "apellidos" => "Barr" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Professor of Pediatrics, Pathology and Medicine, McMaster University, Hamilton, Canada; Co-Chair, Canadian National Task Force on AYA Oncology, and Member, Progress Review Group, National Cancer Institute, USA " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "304v16n65-90367608fig2.jpg" "Alto" => 1166 "Ancho" => 1529 "Tamanyo" => 260932 ] ] "descripcion" => array:1 [ "en" => "Re-configuration of the NCI Clinical Trials Network." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Recognition of the distinctive challenges in providing care to adolescents and young adults (AYA) with cancer has grown over the past 30 years in numerous countries, stimulated in particular by groups of advocates who have in turn raised awareness and philanthropic funding while harnessing sup¿ port from the cancer care community and agencies of fed¿ eral governments. Several examples stand out.</p><p class="elsevierStylePara"> CanTeen (http://www.canteen.org.au) was founded in Australia in 1985 and has grown into a national organization providing support to young people with cancer through more than 250 programs across the country. In recent years it has received substantial funding support from the federal gov¿ ernment. This registered charity provides money for spe¿ cialist hospital care, counselling and individual assistance as well as information and peer support programs.</p><p class="elsevierStylePara"> The Teenage Cancer Trust (TCT) (http://teenagecancer¿ trust.org/) began in the United Kingdom (UK) in 1990 and has built 25 facilities devoted to the care of those in this age group. It hosts biennial international workshops, most recently in July 2014, attracting participants from many countries. Prompted in part by this success, the National Institute for Health and Clinical Excellence in the UK has taken a position on “Improving Outcomes for Children and Young People with Cancer.”<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara"> In the United States of America (USA), LiveStrong (then the Lance Armstrong Foundation that began in 1997) part¿ nered with the National Cancer Institute (NCI) to form a Progress Review Group (PRG) in 2005 that focused uniquely not on a disease but on a population, those in the age range of 15¿39 years.<span class="elsevierStyleSup">2</span> The PRG produced five recommendations (table 1) on which work continues to be undertaken. LiveStrong formed the Young Adult Cancer Alliance, a con¿ sortium of some 150 organizations that has gone on to inde¿ pendence as a new entity called Critical Mass.</p><p class="elsevierStylePara"><img alt="Table 1 Recommendations of the Progress Review Group on Adolescent and Young Adult Oncology (AYAO)" src="304v16n65-90367608fig1.jpg"></img></p><p class="elsevierStylePara"> A National Task Force on AYA with cancer was born in Can¿ ada in 2008 with support from C17, the network of all pediatric cancer programs, and funding provided by the Canadian Partnership Against Cancer, an agency of the fed¿ eral government. The Task Force has hosted biennial inter¿ national workshops<span class="elsevierStyleSup">3,4</span> and produced six recommendations to advance the discipline of AYA oncology.<span class="elsevierStyleSup">5</span> Among its other ac¿ complishments is the design of a national training program for oncologists as an Area of Focused Competence under the auspices of the Royal College of Physicians and Surgeons of Canada.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">The clinical needs </span></p><p class="elsevierStylePara"> A primary challenge is to define the age group that spans the conventional pediatric and adult health care systems, but does not fit well into either with respect to meeting the clinical needs of this population. Although the PRG in the USA adopted the age range of 15¿39, it is clear that the needs of teenagers are substantially different from those who are approaching middle age. Moreover, in industrialized countries the incidence of cancer rises substantially across the PRG-defined age span, from 200 per million in the 15-19 year age group to more than 1200 per million in the 35¿39 group. Accordingly a narrow age range has been used com¿ monly, e.g. 15¿25 for the evolution of specialized clinical services.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara"> Among the self-identified needs of this population is psy¿ cho¿social support as these young people wrestle with such challenges as changes in body image, sexuality, relation¿ ships with family and friends (including partners), return to education and employment, and financial stressors. A spe¿ cific requirement to be met is in fertility preservation<span class="elsevierStyleSup">7</span> that, in the cancer population, has become an emerging disci¿ pline (oncofertility)<span class="elsevierStyleSup">8</span> also.</p><p class="elsevierStylePara"> A case has been made that accrual of AYA with cancer to therapeutic clinical trials has been especially deficient.<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara"> However, with the establishment of an AYA committee with¿ in the Children’s Oncology Group in 2000 there has been recent improvement in this regard and the formation of an intergroup focused on AYA in the re¿structured National Clin¿ ical Trials Network in North America (figure 1) should be a further stimulus to remedying the deficit. This initiative will be able to address the need for AYA specific clinical trials based on the evidence that, for some diseases (well exem¿ plified by acute lymphoblastic leukemia [ALL]) the outcome is better in young adults who are treated according to pedi¿ atric rather than adult protocols.<span class="elsevierStyleSup">10 </span></p><p class="elsevierStylePara"><img alt="Figure 1 Re-configuration of the NCI Clinical Trials Network." src="304v16n65-90367608fig2.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1 </span>Re-configuration of the NCI Clinical Trials Network.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Disease distinctions </span></p><p class="elsevierStylePara"> The spectrum of cancers affecting AYA is distinct from that affecting both younger and older people.<span class="elsevierStyleSup">11</span> Lymphomas, germ cell tumours, thyroid carcinomas and malignant mela¿ noma account for approximately 60% of the total in the age group of 15-29 years (figure 2). An appreciation of this dis¿ tinctiveness led to a proposed new classification of cancer in AYA12 that has been adopted by the Surveillance, Epidemi¿ ology and End Results Program of the NCI in the USA.</p><p class="elsevierStylePara"><img alt="Figure 2 Disease distribution among adolescents and young adults (AYA) with cancer." src="304v16n65-90367608fig3.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 2 </span>Disease distribution among adolescents and young adults (AYA) with cancer.</p><p class="elsevierStylePara"> There is a growing understanding that the characteristics of individual diseases may also be different in AYA. This is true not only of ALL and solid tumours that are more common in childhood but also of some carcinomas, such as those of breast and colon, that are much more prevalent in older adults but do impact on AYA.<span class="elsevierStyleSup">13</span> These differences have impor¿ tant prognostic implications. Moreover, improved knowledge of the differences aid therapeutic decision¿making. For ex¿ ample, more female AYA than older women with breast can¿ cer have familial and “triple negative” disease (devoid of estrogen, progesterone and growth factor receptors). As fur¿ ther evidence of the distinctive phenotypes and genotypes of cancers in AYA become available, this opens avenues for more targeted therapy and better clinical outcomes.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions </span></p><p class="elsevierStylePara"> It is hoped that this brief account of selected aspects of AYA oncology will serve, in some measure, to justify the emer¿ gence of this new discipline. More importantly, it may in¿ crease awareness of the special needs of AYA with cancer and attract a wide variety of health care professionals to form the multi¿disciplinary teams that are essential to the provision of optimal care to this population. Likewise, there are important questions to be addressed in both tumour and host biology. The growing interest in AYA oncology has spawned a new journal <span class="elsevierStyleItalic">(Journal of Adolescent and Young Adult Oncology)</span> and the first textbook devoted to the top¿ ic.<span class="elsevierStyleSup">14</span> Meanwhile the role of advocacy cannot be over¿esti¿ mated. A strong, well¿informed voice in support of AYA with cancer remains essential in harnessing the resources re¿ quired for the development and sustainability of clinical programs focused on the special needs of this population and for a robust, relevant research agenda.</p><hr></hr><p class="elsevierStylePara"> Received: June 2014; <br></br> Accepted: June 2014</p><p class="elsevierStylePara"> *Corresponding author: <span class="elsevierStyleItalic"><br></br> E-mail address:</span><a href="mailto:rbarr@mcmaster.ca" class="elsevierStyleCrossRefs">rbarr@mcmaster.ca</a> (R.D. 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Original language: English
Year/Month | Html | Total | |
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2024 November | 4 | 3 | 7 |
2024 October | 34 | 10 | 44 |
2024 September | 38 | 11 | 49 |
2024 August | 30 | 8 | 38 |
2024 July | 39 | 6 | 45 |
2024 June | 30 | 7 | 37 |
2024 May | 25 | 7 | 32 |
2024 April | 26 | 15 | 41 |
2024 March | 47 | 12 | 59 |
2024 February | 59 | 9 | 68 |
2024 January | 43 | 4 | 47 |
2023 December | 54 | 13 | 67 |
2023 November | 78 | 15 | 93 |
2023 October | 80 | 18 | 98 |
2023 September | 46 | 7 | 53 |
2023 August | 39 | 12 | 51 |
2023 July | 68 | 10 | 78 |
2023 June | 31 | 7 | 38 |
2023 May | 69 | 12 | 81 |
2023 April | 56 | 6 | 62 |
2023 March | 88 | 7 | 95 |
2023 February | 43 | 9 | 52 |
2023 January | 44 | 18 | 62 |
2022 December | 60 | 22 | 82 |
2022 November | 65 | 8 | 73 |
2022 October | 93 | 18 | 111 |
2022 September | 50 | 18 | 68 |
2022 August | 77 | 21 | 98 |
2022 July | 71 | 23 | 94 |
2022 June | 46 | 22 | 68 |
2022 May | 56 | 9 | 65 |
2022 April | 51 | 19 | 70 |
2022 March | 64 | 22 | 86 |
2022 February | 44 | 18 | 62 |
2022 January | 62 | 28 | 90 |
2021 December | 49 | 19 | 68 |
2021 November | 53 | 25 | 78 |
2021 October | 81 | 27 | 108 |
2021 September | 85 | 31 | 116 |
2021 August | 130 | 26 | 156 |
2021 July | 56 | 13 | 69 |
2021 June | 32 | 19 | 51 |
2021 May | 55 | 15 | 70 |
2021 April | 241 | 41 | 282 |
2021 March | 104 | 27 | 131 |
2021 February | 78 | 12 | 90 |
2021 January | 63 | 17 | 80 |
2020 December | 71 | 15 | 86 |
2020 November | 71 | 16 | 87 |
2020 October | 58 | 21 | 79 |
2020 September | 39 | 16 | 55 |
2020 August | 43 | 17 | 60 |
2020 July | 30 | 10 | 40 |
2020 June | 49 | 7 | 56 |
2020 May | 34 | 9 | 43 |
2020 April | 48 | 5 | 53 |
2020 March | 31 | 5 | 36 |
2020 February | 37 | 5 | 42 |
2020 January | 33 | 7 | 40 |
2019 December | 49 | 11 | 60 |
2019 November | 50 | 11 | 61 |
2019 October | 45 | 2 | 47 |
2019 September | 36 | 8 | 44 |
2019 August | 15 | 6 | 21 |
2019 July | 31 | 9 | 40 |
2019 June | 53 | 14 | 67 |
2019 May | 107 | 27 | 134 |
2019 April | 73 | 3 | 76 |
2019 March | 11 | 3 | 14 |
2019 February | 17 | 6 | 23 |
2019 January | 10 | 4 | 14 |
2018 December | 10 | 2 | 12 |
2018 November | 17 | 1 | 18 |
2018 October | 11 | 9 | 20 |
2018 September | 5 | 5 | 10 |
2018 August | 5 | 0 | 5 |
2018 July | 6 | 1 | 7 |
2018 June | 4 | 1 | 5 |
2018 May | 9 | 7 | 16 |
2018 April | 11 | 1 | 12 |
2018 March | 3 | 0 | 3 |
2018 February | 16 | 0 | 16 |
2018 January | 13 | 2 | 15 |
2017 December | 14 | 0 | 14 |
2017 November | 12 | 1 | 13 |
2017 October | 8 | 2 | 10 |
2017 September | 9 | 1 | 10 |
2017 August | 9 | 8 | 17 |
2017 July | 8 | 2 | 10 |
2017 June | 14 | 0 | 14 |
2017 May | 11 | 3 | 14 |
2017 April | 10 | 1 | 11 |
2017 March | 9 | 53 | 62 |
2017 February | 12 | 1 | 13 |
2017 January | 4 | 1 | 5 |
2016 December | 14 | 1 | 15 |
2016 November | 17 | 0 | 17 |
2016 October | 15 | 1 | 16 |
2016 September | 5 | 0 | 5 |
2016 August | 14 | 1 | 15 |
2016 July | 10 | 4 | 14 |
2016 June | 41 | 10 | 51 |
2016 May | 40 | 10 | 50 |
2016 April | 35 | 17 | 52 |
2016 March | 34 | 9 | 43 |
2016 February | 37 | 9 | 46 |
2016 January | 33 | 8 | 41 |
2015 December | 29 | 9 | 38 |
2015 November | 36 | 14 | 50 |
2015 October | 37 | 15 | 52 |
2015 September | 24 | 7 | 31 |
2015 August | 35 | 10 | 45 |
2015 July | 31 | 16 | 47 |
2015 June | 23 | 9 | 32 |
2015 May | 94 | 41 | 135 |
2015 April | 42 | 24 | 66 |
2015 March | 28 | 18 | 46 |
2015 February | 49 | 11 | 60 |
2015 January | 53 | 25 | 78 |
2014 December | 50 | 13 | 63 |