Cancer is the leading cause of death among U.S adolescents and young adults. Despite overall progress in cancer prevention, diagnosis, and treatment, survival rates in this population haven't improved in decades. And a new analysis reveals that those who do survive have poorer-quality lives characterized by unhealthful behaviors, chronic health conditions, and barriers to health care access.
Researchers at the Centers for Disease Control and Prevention (CDC) surveyed 4,054 adult cancer survivors who were 15 to 29 years old when first diagnosed with cancer and compared them with 345,592 people without a history of cancer. The cancers most commonly diagnosed were cervical (38%) and other female reproductive cancers (13%), and melanoma (9%).
Compared with people with no cancer history, survivors of adolescent and young adult cancers had higher prevalences of smoking (26% versus 18%), obesity (31% versus 24%), heart disease and other chronic conditions (14% versus 7%), hypertension (35% versus 29%), asthma (15% versus 8%), disability (36% versus 18%), poor mental health (20% versus 10%), poor physical health (24% versus 10%), and avoidance of medical care because of cost (24% versus 15%).
The biology and treatment of cancer in this group of survivors differ from those in younger cancer patients. “A young woman with breast cancer, melanoma, or a sarcoma is a very different patient than a young child with leukemia,” said Mary McCabe, director of Memorial Sloan-Kettering's Cancer Survivorship Initiative, who wasn't involved in the study.
Adolescent- and young adult–cancer survivors often fall through the cracks, McCabe told AJN, and “may not be treated optimally to ensure that their survival is as good as it can be.” Many will experience late effects of the disease or its treatment, such as cardiovascular or lung disease, several years later. These survivors also face unique challenges regarding fertility and relationships.
“School nurses, public health nurses, and all nurses across the health care system need to watch out for these kids,” said McCabe. That starts with identifying them, then providing education and counseling regarding proper screenings, follow-up care, and making good lifestyle choices.
Good communication may mean contacting survivors through their generation's media. Whereas older patients read printed materials, adolescents and young adults prefer online information and text messages, according to McCabe.
Eric Tai, the CDC report's lead author, told AJN that in order to intervene, nurses must be aware of the long-term risks associated with behaviors that adolescent- and young adult–cancer survivors engage in. Those survivors who smoke, for example, increase their risk of secondary cancers. Tai recommends the Focus Under Forty program, designed by the American Society of Clinical Oncology (www.university.asco.org/focusunder40), for health care providers wishing to learn about the challenges of treating these cancer survivors.—Carol Potera