Emerging Trends in AYA Cancer Care: Aging Young
by Andrew B. Smitherman, MD MSc, and Hazel B. Nichols, PhD
The timing couldn’t have been more perfect when Critical Mass reached out to us about writing a piece for AYA Cancer Awareness Week about emerging trends in AYA cancer care. We had just released an article about how the identification of frailty among survivors may help us provide better survivorship care for this population.
Of the 70,000 adolescents and young adults (AYAs, 15–39 years-old) diagnosed with cancer in the US annually, most will become long-term survivors. Improvements in survival, though, often come at a cost. Survivors of childhood cancers (diagnosed under the age of 21) are at increased risk for chronic physical and mental health concerns due to cancer and its treatment. The long-term health consequences of an AYA cancer diagnosis are still largely unknown. Early results suggest that AYA cancer survivors experience poorer health than the general population. Survivors of AYA cancers, like survivors of childhood cancers, may be at increased risk for developing cardiovascular disease, hypertension, diabetes and poor mental health compared to AYAs without cancer (1). Unhealthy behaviors such as smoking and limited physical activity have also been more commonly reported by AYAs.
In our study of 271 survivors of AYA cancers receiving care at the University of North Carolina Cancer Hospital, we also observed that many physical and mental health concerns were common after AYA cancer (2). Sixty percent of the survivors reported at least one non-cancer health concern, nearly 40% required medication to treat health concerns, and almost 20% reported health problems so severe that they limited daily activity. Commonly reported health concerns included depression (28% of participants), anxiety (27%), asthma (17%), high cholesterol (15%), and hypertension (15%). Many AYA survivors have not been diagnosed with a chronic physical or mental health condition but still struggle with chronic problems such as fatigue, a sense of slowness, or weakness. For this reason, we also investigated frailty, a state of vulnerability to poor health or inability to “bounce back” from illness.
Frailty is commonly related to aging and has been shown to precede the development of chronic health conditions and early mortality in older individuals (see above). In one study, frailty was as common among young adult survivors of childhood cancers (on average around 30 years old) as among men and women in their 60s (3). Similarly in our study, 10% of the AYA survivors met the definition for frailty. This could suggest that AYA cancer survivors experience early aging and may confront disability or quality of life changes at younger ages.
These findings only begin to describe the potential for early aging among AYA cancer survivors, and much more research is needed to better understand long-term health after cancer. Such work will help us gain a clearer understanding of how frailty and comorbidities develop among AYA survivors, who is at greatest risk for these concerns, and how best to prevent them.
This piece is part of the 2018 Adolescent and Young Adult Cancer Awareness Week education series. You can download the Young Adult Cancer Advocacy in Action Toolkit here: https://goo.gl/56rJvk
Andrew B. Smitherman is the UNC AYA Oncology Medical Director. Stemming from combined training in Internal Medicine, Pediatrics, and Pediatric Hematology-Oncology, Dr. Smitherman developed clinical and research interests in providing and improving cancer care for AYAs as well as survivors of childhood, adolescent, and young adult cancers. Supported by a St. Baldrick’s Fellowship and using analyses of administrative databases, Dr. Smitherman has examined the patterns of healthcare usage among survivors to characterize emerging chronic treatment-related morbidities. Building on this work with the support of an NCTraCS career development award, Dr. Smitherman plans to identify biomarkers predictive of these morbidities through prospective cohort studies.
Hazel B. Nichols, PhD is an assistant professor in the epidemiology department. Dr. Nichols’ research addresses hormonally-related factors that are considered during health care delivery (e.g. contraception, breastfeeding, gynecologic surgery, postmenopausal obesity, hormone therapy) and may be targeted by interventions to prevent breast cancer or improve post-diagnosis outcomes. Her work is based in large observational studies and data resources, including the Collaborative Breast Cancer Study, the Sister Study, the Cancer Research Network and the UNC Integrated Cancer Information and Surveillance System. Dr. Nichols is a member of the Cancer Epidemiology Program at the Lineberger Comprehensive Cancer Center and a recipient of the North Carolina Translational & Clinical Sciences Institute (NC TraCS) Scholar Award. She is the lead instructor for the EPID 771 course “Cancer Epidemiology: Survivorship and Outcomes.”
Lauren Lux, LCSW, (on the left in the photo) is a clinical social worker with a passion for working with adolescents and young adults living with cancer. Originally from the Midwest, she completed her master’s in social work at the University of Chicago, and directly after secured grant funding to create the University of Illinois at Chicago Medical Center’s first Pediatric Oncology Social Work program. Lauren was hired as the UNC AYA Program Director in October of 2015 and has been meeting patients and families and growing the program ever since. Her work as Program Director focuses on patient care, psychosocial research, programming, education, and advocacy.
- Tai E, Buchanan N, Townsend J et al. Health status of adolescent and young adult cancer survivors. Cancer (2012); 118:4884–4891.
- Smitherman AB, Anderson C, Lund JL, et al. Frailty and comorbidities among survivors of adolescent and young adult cancer: a cross-sectional examination of a hospital-based survivorship cohort. J Adolesc Young Adult Oncol (2018); Epub ahead of print.
- Ness KK, Krull KR, Jones KE, et al. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: a report from the St Jude Lifetime cohort study. J Clin Oncol (2013); 31:4496–4503.
