Teenagers and young adults with cancer need better access to clinical trials

BMJ 2013; 346 doi: (Published 25 March 2013) Cite this as: BMJ 2013;346:f1959
  1. Zosia Kmietowicz
  1. 1BMJ

The number of teenagers and young adults dying from cancer in the United Kingdom has halved since the 1970s, show figures in a new report. But clinicians have said that too few people in this age group are being enrolled in clinical trials and that the development of new treatments has been poor as a result.

The report from Cancer Research UK said that each year cancer is diagnosed in around 2200 young people aged between 15 and 24 years and that around 310 die from it, down from about 580 deaths a year in the mid-1970s.1

The death rate from cancer in teenagers and young adults fell from 74.5 per million in 1975-77 to 37.7 per million in 2008-10. This decline was against a background of a rising incidence of cancer in young people, from 226 cases per million in 1993-5 to 267 cases per million in 2008-10, with slightly more cases in boys and young men.

Lymphomas are the most commonly diagnosed cancer, accounting for 21% of all cases in this age group, followed by carcinomas (20%), germ cell tumours (15%), brain and other central nervous system tumours (14%), and malignant melanoma (11%).

More than 80% of teenagers and young adults with a diagnosis of cancer survive for more than five years after diagnosis, and survival is improving in most diagnostic groups, expect in patients with bone cancer and soft tissue sarcomas. The greatest increase has been in leukaemias, with the proportion of patients in this age group surviving at five years rising from 49% in 1991-5 to 62% in 2001-5.

The report said that preventive initiatives that focused on the known modifiable risk factors for cancer in teenagers and young adults, such as the human papillomavirus vaccination programme and the ban on under 18 year olds using sun beds, would help reduce the incidence of some cancers in this age group.

But the fact that young adults often had worse survival than children could not be ignored. An analysis of children and of young people aged 15 to 24 between 2001 and 2005 found that five year survival from acute lymphoblastic leukaemia was 61% in young people, significantly less than the 89% in children. Similarly, five year survival from acute myeloid leukaemia was 66% in children and 57% in 19 to 24 year olds.

The difference in survival may be explained by the fact that teenagers and young adults with cancer “fall between two stalls” when it comes to clinical trials, said Kate Law, director of clinical research at Cancer Research UK. Children tend to be treated more aggressively than adults, but in the case of teenagers and young adults doctors were often not sure how to proceed.

Less than a fifth of teenagers and young adults are treated as part of a clinical trial, whereas the proportion of children in trials is 50% to 70%, the report said.

It concluded, “Broadening access to clinical trials is essential, to improve knowledge of the best treatment protocols for the major diagnostic groups, particularly those where survival rates have not improved since the early 1990s.”

Law said that all trials in the fund’s portfolio were now referred for review to see whether teenagers and young adults with cancer could be included in trials for children or adults. Whether they were suitable would be different for each cancer, she added.


Cite this as: BMJ 2013;346:f1959