Adolescents and young adults are of worse prognosis than those of children less than 15 years. Faced with this situation, the Cancer Plan 2009-2013 is committed on specific objectives. Dr. Nadège Corradini, Pediatric oncologist, presents the approach committed to Nantes with the support of the League against cancer.
In 1998, the first States-General of cancer patients and their families, organized by the League, had stressed the special place of older teens and young adult (AYA) in the care system, with notably a real difficulty of social and educational support, isolation in adult or pediatric medicine that goes up to a feeling of double exclusion… Today, the specificity of these cancers is better taken into account, including in the Plan Cancer 2009-2013.
Better to treat the cancers of adolescents and young adults
Cancer is the third leading cause of death among adolescents and young adults (15-25 years), after road accidents and suicides. The prognosis of these cancers is significantly worse than among children under 15 years for most tumors and their support proves to be very heterogeneous. How to explain this worse prognosis? “Today, their support is very heterogeneous. There is also a low rate of inclusion of these age groups in clinical trials and little identified care. Finally, the treatments are often less well followed at this age,”said Dr. Nadège Corradini, specialist paediatrician in Oncology.
The improvement of the support of these young patients has been one of the main objectives of the ‘teens and cancer’ programme launched by the League beginning in 2005. It is today one of the specific objectives of the Plan Cancer 2009 – 2013 which measure 23.5 plans to ‘launch a programme of specific actions towards the adolescents with cancer’, in relying on a multidisciplinary approach, an active collaboration between oncologists pediatricians and adult oncologists, an optimal interaction between the patient, the family, his entourage and caregivers, and psychosocial support and educational support.
The achievements of the “ADO project” developed at Nantes
At the 14th Conference of the League against cancer research, Dr. Nadège Corradini presented the approach developed at Nantes to ensure a better accompaniment for these patients. The will to work together in this context is translated by:
Coordination meetings multidisciplinary interregional adults and children in the field of Hematology, the Allograft and sarcomas;
The establishment of a hospital practitioner full time for the AJA suffering from a malignant hemopathy.
The AJA-specific psycho-social inter-unit meetings;
Consultation specific long-term oncohaematology patients;
The pooling of resources in the field of clinical research: the AJA were included in some adult or Pediatric Clinical trials clinical research unit.
Beyond these therapeutic advances, psychosocial aspects are also taken into account. Word groups have set up at the House of adolescents. All weeks and thanks to the support of the League, a socio-estheticienne and a psychomotor intervene, help these teens have a good image of themselves and to relax.
Create places to live and only places of care
Under action pilot “Espaces Jeunes” initiated by the League against cancer, creating a place of life dedicated, taking account of the specificities and needs of adolescents and young adults with cancer, will be initiated. These places of life (and not care) will be experienced in Nantes and Strasbourg. Prior to their creation, studies on the expectations of these particular patients were conducted through a “focus group” – interviews in December 2010, animated by a researcher teacher in psychology with 9 AJA aged 16 to 22 years. This room will be set up in the year 2012.
With the support of the national cancer Institute, a project of “mobile team AJA” integrating the CHU de Nantes and Angers and Western Cancer Institute will be set up with a doctor, an oncologist, a hematologist, a psychologist, a pedagogical guidance counselor… Its mission will be to support specifically the AJA and provide psycho-social support adapted to their concerns.
Towards a new medical specialty?
To better take care of adolescents and young adults cancers, it is important to develop research projects and common between oncologists pediatricians and adult oncologists clinical research protocols to improve epidemiological knowledge about these cancers increase their inclusion in clinical trials. Through these improvements appear the contours of a new speciality, for a better support for young cancer patients. In order to give new impetus to this project, a French association against the teen/young adult cancers “GO – AJA” will be created in 2012 with the support of the League against cancer.