Critical Issues in Transition and Survivorship for Adolescents and Young Adults with Cancers

Critical Issues in Transition and Survivorship for Adolescents and Young Adults With Cancers By Paul C. Nathan, MD, MSc , Brandon Hayes-Lattin, MD; Jeffrey J. Sisler, MD, MCISc and Melissa M. Hudson, MD

1. The article states that there is a need for the implementation and assessment of adolescent/young adult survivor care strategies. Whereas there are 17 pediatric clinics across Canada, linked by C17 and enrolled in the US based Children's Oncology Group (COG), there are currently only two dedicated young adult clinics in Canada. One is located in Montreal, and the other a support group specifically for young women with breast cancer, PYNK, is located in Toronto at the Sunnybrook Hospital. We have well established pediatric cancer clinics, therefore, the goal shouldl be to chart a path forward that will build capacity, increase the number of young adult cancer clinics across the country and support a level of organization and networking in the young adult cancer field that is comparable to that currently existing for children's cancer.

2. The limitations in cancer center resources (along with survivor preference) strongly suggest that the long-term care of survivors will need to be shared between the cancer centers and primary care providers in survivors' communities. The "shared care" model that the authors suggest may not be the answer because in the real world, shared care in accordance with these principles is not what generally occurs. Although the number of specialized long term follow up (LTFU) programs based at a cancer center or a children's hospital has increased throughout North America, most adolescent and young adult survivors, for a variety of reasons (eg,moves, going off to college), are not followed on a regular basis through such a program. Even when a transition has occurred, survivors often are seen by a primary care physician who did not know them at the time they were treated for their cancer, again because of employment and education or mobility. However, a well-informed primary care practitioner who is alert to the special needs of such patients can play a critically important role in the delivery of timely and often lifesaving health care. Recognizing that most childhood cancer survivors are followed by health care providers who are not familiar with their specific history and risks, the COG has developed (and continues to update) evidence-based screening recommendations for children,