Adolescents and Young Adults
Cancer in Adolescents and Young Adults
Every year in Victoria, around 300 adolescents and young adults (AYA, 15-25 years) are diagnosed with cancer. Approximately 30 adolescents and young adults die from cancer each year in Victoria, making it the leading cause of non-accidental death in this age group in Australia.
Why do AYA participate in clinical trials less often than other age groups?
Cancer biology is not constrained by our societal definition of adulthood (18 years and over). Adolescents aged (15-17 years) develop adult-type cancers, and young adults (18-25 years) develop paediatric-type cancers. For these patients, there is often a disconnect between place of care, tumour-specific oncology expertise, and access to state-of-the-art treatments via clinical trials.
Paediatric cancer clinical trials are increasingly open to participants over the age of 18 years. However, these trials are rarely able to be opened at adult hospitals due to prohibitive cooperative group membership policies or resourcing barriers, and therefore are inaccessible to young adults. Conversely, for adolescents, there are currently few adult cancer trials open to participants below the age of 18 years, even though 16-17 year olds can access care at an adult hospital.
Consequences of low AYA clinical trial participation
The barriers described have resulted in AYA clinical trial participation rates that are lower than for younger children or older adults, which is an issue of international concern.
Participation rates are highly correlated to survival gains through improvements to standard care practices over time. Survival gains are lowest in the AYA age group. In addition, barriers to clinical trial participation can prevent access to experimental drugs that represent a last remaining treatment option where standard of care has failed. Experimental drugs can be life-saving, life prolonging, and/or provide improved tolerability compared to existing standard of care options.
Increasing AYA Access to Clinical Trials Program
The VCCC Increasing AYA Access to Clinical Trials Program aimed to identify local barriers and solutions to AYA clinical trial access in the metropolitan Melbourne setting.
Many of these solutions may be relevant in other healthcare settings across Australia and internationally. To enable translation to other settings, we have created an AYA Clinical Trial Access Toolkit, which provides access to the solutions-based knowledge products arising from our work.