Adolescents and Young Adults with Cancer

Individuals aged between 15 and 39 who are unfortunately diagnosed to have cancer are classified as "adolescent and young adult (AYA) cancer patients." In most of the international and European guidelines. According to the the statistics from the Surveillance, Epidemiology, and End Results (SEER) database in 2019, there were approximately 1.2 million new cases of cancer among AYAs worldwide, accounting for 5% of all new cases. Over the past four decades, the incidence rate of cancer among AYAs has increased by 30%. 

According to a report from the Hong Kong Cancer Registry, there were 1,590 new cases of AYA cancer in 2021, among which breast cancer and thyroid cancer recorded the highest incidence rates. 

Around 90% of AYA cancer patients are diagnosed with leukaemia, lymphoma, sarcoma, melanoma, breast cancer, cervical cancer, testicular cancer, colorectal cancer, and brain cancer. On top of that, thyroid cancer and stomach cancer are relatively common among AYAs. 

Previous studies showed that the survival rates of AYA cancer patients are comparable to those of older patients. However, due to their young age, it is vital to pay attention to their physical health and mental wellbeing development, especially for teenagers who are in their developmental and educational stages, and require different types of family and society support compared to adults. 

1. Lack of awareness

• There is a lack of public awareness and understanding on the specialised care and management that AYA cancer patients need.

2. Mental care

• AYAs have more complex psychological needs, such as establishing self-image, recognition, interpersonal relationships, peer support, sexual orientation, and privacy. AYAs may also display a rebellious attitude and a sense of adventure, making them more prone to smoking, drinking, substance abuse, or even suicidal ideation. 
  

3. Fertility

• Chemotherapy and radiation therapy can potentially reduce or damage their sperms and eggs. Fertility counselling and preservation options, including saving sperm, egg, embryo or ovarian tissue, should be offered before treatment to preserve the possibility of future parenthood.

4. Long-term side effects

• Chemotherapy, targeted therapy, and radiation therapy may cause long-term side effects. For example, certain chemotherapy like doxorubicin can affect the heart; second malignancy may develop years after radiation therapy. Additionally, some cancer patients have to take supplements or medications over a long period of time, for example levothyroxine for thyroid cancer patients after thyroidectomy. Regular long-term follow-up assessments are necessary for AYA patients. 
  

5. Rehabilitation

• AYA cancer patients often suffer from a prolonged recovery process. Not only do they need to undergo psychological counselling, their education and employment may also be affected by the treatment. Many AYA survivors lack of confidence in resuming their study or work and may require support e.g. financial assistance to help them gradually reintegrate into the society. 

To all AYA cancer patients, this journey of cancer fighting is not easy. Stay strong and never give up!  

Special thanks to Dr. Wendy Wing-Lok Chan, Department of Clinical Oncology, the University of Hong Kong, for authoring and editing this article.