Young people with cancer fall into the
gap between adult and paediatric oncology services and Australia needs
to re-think current treatment of young cancer patients, according to
a paper by Dr David Thomas and colleagues in the Internal Medicine
Journal (IMJ), the official journal of the Adult Medicine Division
of The Royal Australasian College of Physicians (RACP).
The current debate is about the ‘grey zone’ between 15
and 35 years of age. In 2001, there were 1751 Australian patients diagnosed
with cancer between the ages of 15 and 30 years, compared with 603
patients under the age of 15 years. Recent data suggests that improvements
in outcomes of cancer in young people lag well behind the advances
that have been achieved for both children and older adults in the past
30 years.
“ The physical, emotional and social challenges facing young
people with cancer remain among the most difficult faced by patients,
families and health-care providers. These include balancing young people’s
needs for autonomy and independence with parental demands; promoting
continued engagement in education despite treatment; facilitating social
development and handling peer pressure and managing the effect of cancer
on sexual maturation and intimacy,” Dr Thomas said.
“ Isolation is a very important psychological issue for
young people with cancer. Many young people risk losing contact with
their
key providers of social support during treatment. This is not only
because of school absence but also because healthy peers commonly find
it hard to empathize with the experiences of young people as patients.
Obviously, isolation is also a major challenge for rurally based young
people.”
Young people may also feel isolated from their own healthcare team,
as health-care professionals report greater difficulty communicating
with young people than other age groups. Furthermore, there is evidence
that health professionals avoid discussion of emotionally charged issues
in younger patients.
“ We need to ensure health professionals in adolescent health
are both competent and confident in communicating with young people
as well as their families,” Dr Thomas said.
One of the problems with the current system is the relative rarity
of individual cancers in young people when compared with either children
or adults, which results in treatment being dispersed throughout many
centres. As a result, few institutions develop sufficient clinical
expertise or participate in clinical trials and most are unable to
afford the specialized infrastructure needed for dedicated psychosocial
support. The scarcity of patients also means few hospitals are able
to provide an appropriate environment of peer support, whether in terms
of inpatient or outpatient settings.
“ We need to develop a solution to this issue while balancing
two important principles, namely, that regardless of location, all
Australians should have equal access to the best possible care including
psychosocial support and that care should be delivered as close as
possible to home.”
_ One of the ways we could address
this issue is to provide specialized medical and psychological
support remotely, by encouraging
local clinicians
to work with others with expertise in the area while also ensuring
proper psychological support is provided.
_ One model is that the patient’s case would be reviewed by
local clinicians in conjunction with a group embodying wider expertise,
resulting
in a comprehensive management plan. This approach would result in standardized
treatment based on best practice and would be expected to enhance health
outcomes. Online support using Web-based resources, may also be a powerful
way of ensuring that both clinical treatments and psychosocial supports
remain on track,”
Dr Thomas said.
onTrac@PeterMac, Australia's only coordinated program
for adolescents and young adults with cancer, has dedicated the
past two years to building
best-practice for the care of patients in this age group. The program,
which is philanthropically funded by Telstra, is now working to develop
remote-practice solutions.
The RACP is responsible for training, educating and representing
over 9,000 physicians in Australia and New Zealand. The RACP represents
25 medical sub-specialties including paediatrics, public health and
occupational medicine. Physicians are often called specialists and
are doctors who have completed an extra six years or more of training
after their initial medical training and choose to specialise in
a
particular area of medicine. News
is included on this website to inform visitors about current health
issues, but not to endorse
any particular view
or activity. The views stated in the article above are not necessarily
those of IvyRose Ltd.. Material in this news item was released
by the Royal Australasian College of Physicians on 10 April 2006.
For further information, please visit their website
using the
link below.
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