Dr. Monica Dragomir, head of the pediatric oncology department at the Bucharest Oncological Institute, warns that teenagers and young adults in Romania, diagnosed with cancer, face a lower survival rate than children, a group in which there has been an increase significant survival rate. Late diagnosis and quality of treatment are essential factors in this situation.
More and more teenagers and young people are fighting with oncological diseases – Photo Archive
“The category of adolescent and young adult oncological patients is a special category in oncology and with many particularities related to age, related to pathology, related to treatment modalities and, unfortunately, not least, particularities related to survival, chances of survival , of treatment possibilities for children and adults. This age category in all the epidemiological statistics communicated so far has a lower survival rate compared to children, the category 0-14 years and compared to adults, older patients, 25, 29 years and even more. This phenomenon has interested everyone, what are the causes, and especially what we can do“, explained Dr. Monica Dragomir, in an interview with News.ro, according to Digi24.
“There are many causes that can be involved in the lower chances of survival in this age group, primarily related to the late diagnosis, in advanced stages. On the other hand, the treatment possibilities and the location where the oncological treatment is carried out, in a children's section attached to the pediatric oncology section or in an adult section. Depending on the legislation of each country and the views of each medical system, things are one way or another. None is favorable to this category if there are no compartments dedicated to them, with all facilities, from all points of view“, adds the doctor.
Lower survival rates
There are other causes that contribute to a lower survival rate in adolescents and young adults compared to children, such as lower participation in clinical trials and limited access to modern, personalized therapies.
“Another reason why the survival rate of adolescents and young adults is lower is that they do not always appear in clinical trials that are carried out in children or adults or, if we refer to patients under 18 years of age, before the age of 18 they do not have access to effective, modern medication, new medication, targeted therapies, immunotherapies that have been developed in recent years for cancers that they experience, cancers identical to those of adults. And that's because the respective medicines are not registered anywhere and for the age category under 18, so called out of label“, stated Dr. Dragomir.
Recently, the number of children over the age of 15 diagnosed with cancer has increased significantly. These patients are maintained in treatment and monitored at the Bucharest Oncological Institute even after reaching the age of 18. At the same time, we observe an upward trend in terms of the survival rate in the case of pediatric cancers as a whole, says Dr. Dragomir.
“Referring to the addressability to our Institute, I have had many patients, perhaps more recently over 15 years of age. We maintain in treatment and monitoring patients who are over 18 years old, but are diagnosed a little earlier than reaching this age which is considered standard between child and adult in our healthcare system. What I said earlier, that the chance of survival is lower, was also demonstrated in the epidemiological study of the National Cancer Registry, the last survival study that was made public on February 15 on the occasion of the pediatric cancer awareness day brought some incredibly good data, the increase in survival in childhood cancers as a whole, is a significant increase if we refer to the interval, which is very short, I mean the interval 2014 – 2017 versus 2010 – 2013, so in children we have a survival of the category 0-14 years from 69 to 74%, 5 percent is incredible for an interval of only four years, and comparatively, for teenagers, 15-19 years, the increase was significantly lower.
It started from less, 65%, and only increased to 68%, so the difference is noticeable and demonstrated on our statistics and on the epidemiological statistics of the National Cancer Registry, which is an extremely serious approach to pediatric oncology, represents a standard of the European International Society of Pediatric Oncology and our pediatric hemato-oncology registry dates from 2010, has national and international recognition, and the data and epidemiological studies are validated by colleagues from the European network of cancer registries“, mentioned Dr. Monica Dragomir.
Oncological conditions in children, adolescents and young people
According to the doctor, leukemias, lymphomas and brain tumors predominate in children. In contrast, in adolescents, bone cancers record a peak incidence.
“The pathology in adolescents and young adults – and I can extend the comment to 29 years old – is a hybrid, between pathology specific to children, but in a much smaller number and percentage, associated with pathology specific to adults. Leukemias, lymphomas, brain tumors, child-specific tumors, neuroblastoma, nephroblastoma dominate in children. All these also exist in teenagers, young adults, but in smaller percentages. Overall about 45, less than 50%. A percentage of 5-10% is occupied by germinal tumors that are located in the testicle, ovary. They occupy about the 2nd place in this age category. Bone cancers, osteosarcoma, Ewing sarcoma have a peak incidence in adolescents, Hodgkin's lymphomas are also common, leukemias to a lesser extent compared to children, and a percentage of about 40-45% is represented by carcinomas, it is a generic term for several adult-specific cancers, I mean carcinomas of the breast, digestive tract, lung, cervix and so on“, stated Dr. Dragomir.
The distribution of oncological diseases among children and adolescents is clear, but the identification of causal risk factors is difficult. There is a familial risk of cancer, but this is a small percentage of cases and requires limited attention.
“This distribution of oncological diseases has been observed for a very long time and without direct implications of risk factors. But if we refer to causal risk factors, here it is extremely difficult to support theories. There is definitely a category of patients with a family risk of cancer which means risk of getting cancer both in childhood, as well as in adulthood. This requires relatives, especially first-degree relatives with cancer, the risk of cancer is inherited, not cancer, and there are many known situations, genetic statuses that involve the risk of cancer. Then, there are a series of congenital diseases, hereditary conditions that predispose to cancer, but these represent a very small percentage, they do not deserve much attention“, said the doctor.
In general, risk factors such as diet, lifestyle and smoking, which are involved in cancer in adults, do not have a significant impact on the occurrence of cancer in children and adolescents. Although adopting a healthy lifestyle is beneficial in the long term, it is not a determining factor in preventing cancer at a young age.
“If we refer to the large mass of diagnosed patients, apart from a family risk of cancer, they do not associate a predisposition to cancer. Let's talk about diet, lifestyle, smoking, all of which are involved in the etiology of adult cancers, digestive cancers, broncho-pulmonary cancer, are influenced by these risk factors, recognized by everyone. Of course, if we are referring to a child, teenager, a healthy and correct diet is a good attitude, movement, more time outdoors and less in front of the computer, is beneficial for health, but we cannot involve carcinogens associated with known risk factors of be involved in the etiology of cancer in the appearance of cancer at a young age, because their period of action is 15-20 years. The healthy lifestyle that we must accustom our children to from the earliest age in order to acquire healthy habits uses to avoid the occurrence of cancer in adulthood, but we cannot involve them in the occurrence of cancer in children and adolescents“, detailed Dr. Dragomir.
