Surveillance and Management of Late- and Long-Term Effects in AYA Cancer Survivors
1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Answer: According to the National Cancer Institute, each year approximately 90,000 adolescents and young adults (AYA) between 15 and 39 years of age are diagnosed with cancer in the United States, which makes cancer the leading cause of disease-related death for this group. While survival outcomes in this population have lagged behind that of childhood- and adult-onset cancer, there are over 600,000 AYA cancer survivors and that number is expected to grow. After completion of treatment, AYA survivors are at an increased risk of experiencing physical effects of treatment (e.g. cardiovascular disease, early menopause, infertility, neuropathy) as well as psychological effects (e.g. depression, anxiety, and fear of recurrence) compared to their peers. Survivors of AYA cancers are also at a significantly increased risk of subsequent cancers. Unfortunately, they too often find themselves in a cancer care system designed for older adults or young children and lack guidelines for surveillance and management of treatment-related effects and supportive care services. Health care providers caring for AYA survivors are often left to "extrapolate" recommendations based on childhood or adult-based survivorship guidelines.
2. Why are you struggling with this issue?
Answer: With clinical decision-making often based on evidence derived from other patient populations that may not reflect optimal management for AYA patients, a systematic review of evidence on age-appropriate surveillance and management of late effects in AYA patients and supportive care interventions will help the American Society of Clinical Oncology (ASCO) develop a clinical practice guideline to establish a common vision and integrated strategy for survivorship care for these patients.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
Answer: AYA survivor care remains under-resourced, uncoordinated, and sub-optimal. To help address these needs, ASCO's Survivorship Guidelines Advisory Group is committed to providing strategic guidance on issues related to AYA survivorship. As clinical decision-making is often based on evidence derived from other patient populations, a systematic collection of evidence specific to the AYA population will help inform optimal management for AYA survivors.
4. When do you need the evidence report?
Answer: January 2022
5. What will you do with the evidence report?
Answer: The evidence report will be used as an evidentiary base upon which an expert panel will develop evidence-based recommendations and produce an ASCO Clinical Practice Guideline.
