Adolescent and Young Adult (AYA) Cancer Survivorship Practices: An Overview

Abstract

Worldwide, more than 1.2 million adolescents and young adults (AYAs; those aged 15-39 years) are diagnosed with cancer each year. Although considerable variability exists according to cancer site and stage of disease, the 5-year relative survival at the time of diagnosis has been estimated at >80% for all AYA patients with cancer combined. Extensive survivorship research in recent decades has focused on patients diagnosed with cancer as children (<15 years) and older adults (>39 years), yet few studies to date have reported outcomes specifically for patients diagnosed as AYAs. With increasing incidence and improving survival for many tumor types, leading to the majority of AYA patients with cancer becoming long-term survivors, there is a critical need for research efforts to inform the survivorship care of this growing population. This article describes the population of AYA cancer survivors according to their epidemiology and late and long-term effects, the challenges and models of AYA survivorship care, as well as future opportunities for research and healthcare.

Keywords: AYA; AYA care programs; adolescents and young adults; cancer; survivorship.

Figure 1

Primary tumor treatment, early survivorship, and late survivorship, partially adapted from the American Cancer Society [11]. Survivorship starts at the termination of the initial treatment. In the case of long-lasting adjuvant hormonal treatment after initial adjuvant chemotherapy, survival time, in our definition, starts at the end of chemotherapy. During survivorship, survivors attempt to transition to the ‘new normal life’, which can be subdivided into early and late survivorship [12]. Early survivorship covers the first 5 years since the termination of initial treatment [excluding maintenance therapy] and late survivorship from 5 years onwards since the end of initial treatment. For patients with a poor prognosis at diagnosis, survivorship starts at diagnosis. They have to live with a life-limiting disease.