Australia Needs to Improve Management of Young People with Cancer

Melbourne, Australia - Young people with cancer fall into the gap between adult and paediatric oncology services and Australia needs to re-think current treatment of young cancer patients, according to a paper by Dr David Thomas and colleagues in the Internal Medicine Journal (IMJ), the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP).


The current debate is about the ‘grey zone’ between 15 and 35 years of age. In 2001, there were 1751 Australian patients diagnosed with cancer between the ages of 15 and 30 years, compared with 603 patients under the age of 15 years. Recent data suggests that improvements in outcomes of cancer in young people lag well behind the advances that have been achieved for both children and older adults in the past 30 years.


“The physical, emotional and social challenges facing young people with cancer remain among the most difficult faced by patients, families and health-care providers. These include balancing young people’s needs for autonomy and independence with parental demands; promoting continued engagement in education despite treatment; facilitating social development and handling peer pressure and managing the effect of cancer on sexual maturation and intimacy,” Dr Thomas said.


“Isolation is a very important psychological issue for young people with cancer. Many young people risk losing contact with their key providers of social support during treatment. This is not only because of school absence but also because healthy peers commonly find it hard to empathize with the experiences of young people as patients. Obviously, isolation is also a major challenge for rurally based young people.”


Young people may also feel isolated from their own healthcare team, as health-care professionals report greater difficulty communicating with young people than other age groups. Furthermore, there is evidence that health professionals avoid discussion of emotionally charged issues in younger patients.


“We need to ensure health professionals in adolescent health are both competent and confident in communicating with young people as well as their families,” Dr Thomas said.


One of the problems with the current system is the relative rarity of individual cancers in young people when compared with either children or adults, which results in treatment being dispersed throughout many centres. As a result, few institutions develop sufficient clinical expertise or participate in clinical trials and most are unable to afford the specialized infrastructure needed for dedicated psychosocial support. The scarcity of patients also means few hospitals are able to provide an appropriate environment of peer support, whether in terms of inpatient or outpatient settings.


“We need to develop a solution to this issue while balancing two important principles, namely, that regardless of location, all Australians should have equal

access to the best possible care including psychosocial support and that care should be delivered as close as possible to home.”


“One of the ways we could address this issue is to provide specialized medical and psychological support remotely, by encouraging local clinicians to work with others with expertise in the area while also ensuring proper psychological support is provided.


One model is that the patient’s case would be reviewed by local clinicians in conjunction with a group embodying wider expertise, resulting in a comprehensive management plan. This approach would result in standardized treatment based on best practice and would be expected to enhance health outcomes. Online support using Web-based resources, may also be a powerful way of ensuring that both clinical treatments and psychosocial supports remain on track,” Dr Thomas said.

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This study is published in the April issue of the Internal Medicine Journal (Vol. 36, Issue 4). Media wishing to receive a PDF, please contact alina.boey@asia.blackwellpublishing.com