Young Adult Cancer Survivors May Face a Challenging Future

Adolescent and young adult cancer survivors must be their own advocates to live long and well.

This becomes increasingly important as statistics from a recent survey of doctors showed a lack of knowledge of the late effects of common chemotherapy drugs used to treat breast and colorectal cancers. More than 2,000 oncologists and primary care physicians were asked to identify late effects of four chemotherapy drugs used for breast and colon cancers: doxorubicin, oxaliplatin, cyclophosphamide and  paclitaxel. 

Of the primary care doctors, only 55 percent knew that cardiac problems could be a late effect of doxorubicin. About 27 percent and 22 percent, respectively, knew that paclitaxel and oxaliplatin could cause peripheral neuropathy. Oncologists performed better on the survey, with 62 to 97 percent being able to connect the drug to a late effect. 

In February 2012, the National Comprehensive Cancer Network responded to many of these concerns with new practice guidelines for the AYA patient population that address the “critical issues that AYA patients with cancer and their caregivers encounter at diagnosis, during treatment and after therapy.” The guidelines also call for AYAs to be assessed across domains of individual function, relationships, socioeconomic issues and supportive care services/interventions. In each of these categories the NCCN offers recommendations.

The “AYA gap” has also garnered researchers’ attention because of the lack of improvement in survival—unlike the age groups on either side—prompting some to call for more clinical trials for the AYA population. 

Researchers in this area point to the need for improvement in the survival rate for this age group of around 70,000 new patients a year—nearly eight times the number of new diagnoses of those under 15. Researchers also ask that because of the unique emotional and physical aspects of AYA cancer, it become a separately recognized specialty within oncology. 

In its guidelines, the NCCN lists the most common cancers for the AYA population, which include not only those more identified with younger AYA patients, such as Hodgkin lymphoma, but also those associated with older adults, such as cancers of the breast, thyroid and colon.

The guidelines call for monitoring when “certain medications associated with irreversible organ damage may be essential” for treatment. For these drugs, the toxicities can be associated with cardiac, renal or hearing impairment. 

Oeffinger served on the panel that created the NCCN guidelines and has a particular interest in the follow-up and monitoring that will help AYA patients go on to live long, productive and meaningful lives.

“Whether we are talking about someone with testicular or ovarian or breast cancer at a young age, many of these patients have an increased risk for heart disease,” he says. “Sometimes it’s directly related to therapy and often it’s indirectly related.” 

Talk about this article with other patients, caregivers, and advocates in the Childhood Cancers CURE discussion group.
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