The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review

Abstract

Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010-2020 that included: (1) cancer survivors who were AYAs (age 15-39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.

Keywords: adolescent and young adult; cancer survivors; chronic disease; mortality; second malignant neoplasm.

Figure 1

PRISMA flow diagram for the study selection process. Abbreviations: SMN, subsequent malignant neoplasm.

Figure 2

The number of studies included in the scoping review for each outcome of subsequent malignant neoplasms, chronic conditions, and mortality according to year of publication. Duplicates (studies containing information on more than one outcome) were removed from the line indicating the total number of studies.

Figure 3

Descriptive representation of the direction of effect for patient-, tumor-, or treatment-related factors described in three or more studies on the risk for subsequent malignant neoplasms, chronic conditions and hospitalizations, and late mortality among AYA cancer survivors in cohorts with combined cancer types. Deeper colors represent more studies (n = 5) and white cells represent that no study investigated that risk factor (n = 0). Reference categories appear in parentheses. Abbreviations: AAPI, Asian-American and Pacific Islander; NS, non-significant; SES, socioeconomic status; SMN, subsequent malignant neoplasm.