Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Teenagers and Young adults with testicular cancer – a special case or just adolescent angst?
- Sara Stoneham, Hiten RH Patel, Section of Laparoscopic Urology, UCLH (21 April 2008)
|
|
|||
|
Sara Stoneham, Consultant Paediatrician, Teenage Cancer Centre, Univerisity College London Hospital,l W1W 7EY, Hiten RH Patel, Section of Laparoscopic Urology, UCLH
Send response to journal:
|
We read with interest the editorial discussing the follow up of children with cancer1. A diagnosis of cancer is often the start of a life –changing journey which may culminate in significant psychological and physical morbidities. The ‘Cancer Patient’ label remains with many long after they are cured. However, by providing age appropriate, multidisciplinary care the need for protracted follow up may be reduced. Teenagers and young adults (TYA) are a complex, challenging and rewarding patient group to care for. The National Institute for Clinical Excellence (NICE) Improving Outcomes Guidance for paediatric and adolescent cancer together with initiatives from the National Cancer Research Institute (NCRI) support the recognition that the needs of children and young people with cancer are different from those of older adults and should be provided for accordingly2. Historically, adolescents have had varying routes of entry into cancer care. They have been managed by health professionals trained in differing disciplines; often with a non-uniform approach to therapy. This discrepancy has implications not only for the choice of curative therapies but also for the burden of late effects. At present, no national or international consensus exists to describe the optimal care pathway for all adolescent cancer patients. Within the TYA group, testicular cancer remains the most common malignant disease of young men 3. The advent of platinum-based chemotherapy options has allowed testicular cancer to become one of the more treatable malignancies, with survival outcomes often exceeding 90%4. Quality of life offered to this survivorship is therefore an important therapeutic goal. We know that access to clinical trials improves cancer survival outcomes however the recruitment rate of the TYA testis cancer population remains poor4. Contributing factors may include the potential to be recruited into competing adult and paediatric clinical trials, lack of nationally agreed consensus treatment protocols and the well described psychosocial barriers for TYA trial recruitment. 5-7 One way of overcoming some of these barriers is to centralise the care package for these patients. Eight TYA cancer units are already well established in the U.K. and more continue to be developed. Their primary role is to provide not only an environment suitable for this age group but also to allow access to a wider multidisciplinary team experienced in the care for teenagers and young adults with cancer. Discussion of these patients in supra – regional disease specific MDTs can then facilitate contact with the other specialist teams required in the treatment and care of the patient. The holistic care of TYA patients treated within the London Bone and Soft Tissue Sarcoma Service successfully demonstrates the viability of this model. Another example of focussed work within a specialised centre would be a TYA patient with testis cancer requiring Retroperitoneal Lymph node dissection (RPLND). The need for RPLND may arise when metastatic retroperitoneal disease has not adequately responded to primary chemotherapy treatment. This specific surgical procedure is generally performed by an open technique in most treatment centres but in a few more specialist units this can be safely performed laparoscopically. Laparoscopic RPLND has many advantages over conventional open surgery namely: a relatively bloodless operating field minimising tissue damage; better cosmesis; shorter hospital stay and early return to normal activity8. Thus the patient can have care delivered in an age appropriate environment supported by TYA psychosocial MDT; have his management discussed in a disease specific MDT and also access specialised surgical techniques from experienced surgeons. This model works towards optimising curative therapy; minimising acute and long term morbidity and helps address quality of survivorship issues. Therefore, we propose that age- appropriate TYA cancer units with access to disease specialist MDT’s; opportunities for enrolment on national consensus trials and access to specialist non-invasive surgical techniques should be the ideal model of care for this small but unique cohort of adolescent cancer patients. 1. Jenney M, Levitt G. Follow-up of children who survive cancer. BMJ. 2008;336(7647):732-3 2. Improving outcomes with children and young people with cancer. Guidance on cancer services. 2005 www.nice.org.uk 3. Quinn, M., Babb P, Brock A,Kirby L and Jones J. Cancer Trends in England & Wales 1950-1999. . , Vol. SMPS No. 66. 2001: TSO. 4. Oldenburg J, Lehne G, Fosså SD. Tidsskr Nor Laegeforen. Testicular Cancer. . 2008 Feb 14; 128(4):457-60.5 5. Ferrari A, Montello M, Budd T, Bleyer A. The challenges of clinical trials for adolescents and young adults with cancer Pediatr Blood Cancer. 2008 May; 50(5 Suppl):1101-4. 6. Shaw, P H; Ritchey, A K. Different Rates of Clinical Trial Enrolment between Adolescents and Young Adults Aged 15 to 22 Years Old and Children Under 15 Years Old with Cancer at a Children's Hospital. . Journal of Pediatric Hematology/Oncology. 29(12):811-814, December 2007 7. Whelan J and Fern L National Cancer Research Network 2006 . unpublished data 8. Nielsen ME, Lima G, Schaeffer EM, Porter J, Cadeddu JA, Tuerk I, Kavoussi LR. Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer. . Urology. 2007 Dec;70(6):1168-72. Competing interests: None declared |
|||