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Teens, Young Adults Missing Out on Latest Cancer Advances
Date:1/25/2008

Treatment gap between pediatric and adult cancer care one reason why, study reports,,,,

FRIDAY, Jan. 25 (HealthDay News) -- When it comes to getting cutting-edge treatments for cancer, teens and young adults might be missing out.

In a study of young oncology patients, researchers found that 38 percent of those under 15 participated in a clinical trial, while just 27 percent of those over 15 were enrolled in a clinical trial. With the overall cancer survival rate lower among teens and young adults than it is among younger children, access to clinical trials appears to be a contributing factor, the researchers noted. In many cases, a clinical trial simply wasn't available for the adolescents, according to the study, which was published in a recent issue of the Journal of Pediatric Hematology/Oncology.

"We've known for several years that older adolescents and young adults don't have the same clinical trial rate as younger patients but didn't know all of the reasons why," explained study author Dr. Peter Shaw, director of the Adolescent and Young Adult Oncology Program at Children's Hospital of Pittsburgh.

"This study showed that the number one cause they're not put into clinical trials was that there aren't clinical trials available for them. Another reason is that many are referred to adult oncologists who may not be as familiar with pediatric disease and its patterns," said Shaw. "And that translates into worse survival rates, because clinical trial enrollment is correlated with better survival when it comes to cancer."

The current study included data from 640 children, adolescents and young adults with cancer who were treated at the Children's Hospital of Pittsburgh between July 2001 and June 2006. Five hundred and one were under 15. Overall, 36 percent were treated in a clinical trial, according to the study.

In the older age group, 57 percent weren't enrolled in a clinical trial because none were available. In children under 15, that number was 41 percent.

"Now that we realize that there's such a deficit, we have to make hard decisions about which clinical trials to run. Funding has been cut and that impacts how the Children's Oncology Group operates. Less protocols can be open," said Shaw.

"This is a historical problem. Some of the diseases span an 18-year range and have never been the domain of either pediatrics or adult oncology," said Dr. Richard Gorlick, division chief of pediatric hematology/oncology at The Children's Hospital at Montefiore in New York City.

"There's not necessarily a fixed dividing line when you think of pediatric or medical [adult] oncology," said Gorlick. "There's been a blurring of the age boundary, and adolescents and young adults should be treated by a provider who has the most expertise in their particular cancer area. The rare adolescent who has colon cancer would probably be better suited to being treated by a medical oncologist. But an adolescent with sarcoma, lymphoma or leukemia may do better with a pediatric oncologist. It all depends on the diagnosis."

Ideally, Shaw said that adolescents and young adults diagnosed with cancer will see both a pediatric and a medical oncologist to make sure they're getting the best treatment possible. Or, even better, he said, is to find an adolescent and young adult cancer treatment program.

More information

To gain a better understanding of the risks and benefits of clinical trials in cancer treatment, visit the Teens Living with Cancer.



SOURCES: Peter Shaw, M.D., pediatric hematologist/oncologist, and director, Adolescent and Young Adult Oncology Program, Children's Hospital of Pittsburgh; Richard Gorlick, M.D., associate professor, pediatrics and molecular pharmacology, and division chief, pediatric hematology/oncology, The Children's Hospital at Montefiore, New York City; December 2007, Journal of Pediatric Hematology/Oncology


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