Enhancing Adolescent and Young Adult Oncology Research Within the National Clinical Trials Network: Rationale, Progress, and Emerging Strategies
Section snippets
Rationale: Why Involvement of Adult Nctn Groups Is Essential for Aya Oncology
Confronting the AYAO population are several challenges that impede progress in improving survival. These include inferior geographic access to care,3 insurance,3 tolerance of therapy,4 and treatment adherence.5 There appear to be biological differences in some histologically similar malignancies presenting in pediatric, AYA, and older patients.6 In addition, there likely are substantial developmental differences in pharmacokinetics/pharmacodynamics that influence toxicity and efficacy.7
Critical
Aya Oncology and The Nctn: Recent Progress
The recent restructuring of the NCI-supported cooperative group trials network has significant potential to advance AYAO research. In March 2014, following recommendations from the Institute of Medicine,19 the nine previous adult cooperative groups were merged into four (NRG Oncology, Southwest Oncology Group [SWOG], Alliance Oncology, and Eastern Cooperative Oncology Group American College of Radiology Imaging Network [ECOG-ACRIN]). This reorganization helped form the NCI National Clinical
Strategies for Facilitating Ayao Research In The Nctn Groups
In addition to the federal initiatives noted above, internal cooperative group opportunities are available for enhancing AYA-focused research. In 2002, the COG became the first North American cooperative oncology group to develop a formal committee devoted to AYA oncology. The overall objective of the COG AYA Oncology Discipline Committee is to improve survival and quality of life for AYA patients through a greater understanding of differences in cancer and host biology, and their adjustment to
Conclusion
Due to the unique convergence of age, diseases, and characteristic clinical challenges, enhancing AYAO research requires deep integration of pediatric and medical oncology expertise. With creation of the NCTN, an unprecedented historical opportunity has arrived for achieving this. Individual NCTN groups have already spawned new studies, formed AYA committees, and launched other initiatives to increase AYAO research internally. The next frontier is AYA integration across the NCTN groups and
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Survival by age in paediatric and adolescent patients with Hodgkin lymphoma: a retrospective pooled analysis of children's oncology group trials
2022, The Lancet HaematologyCitation Excerpt :Despite continued progress,1,2 population-based studies report worse outcomes in patients aged 15–39 years compared with patients in younger and older age groups.3,4 Proposed hypotheses for these disparities include age-associated differences in health-care access,4 clinical trial enrolment,5 survivorship care,6–8 and the unique psychosocial needs of adolescents. Another potential explanation for age-associated survival differences in patients with Hodgkin lymphoma is the possibility that host or tumour biology, and by extension, therapeutic efficacy, might differ across the age spectrum.
The management of Hodgkin lymphoma in adolescents and young adults: Burden of disease or burden of choice?
2018, BloodCitation Excerpt :The NCTN has a specific emphasis on enhancing care for AYA patients through the expansion of clinical trial access via cross-group enrollment, the formation of trials with broader age eligibility, and improved availability of trials in communities with a high prevalence of AYA patients. In addition, the NCTN aims to enhance “supportive care, access to care, health care transitions, mobile health technologies, and health care delivery systems,” all of which are known barriers for AYA patients.37 Today, the COG continues to work together with The Alliance Advocacy Group to form a clinical trial open specifically to AYA patients with HL7 that will have substantial positive repercussions for this population.
Inclusion of a core patient-reported outcomes battery in adolescent and young adult cancer clinical trials
2023, Journal of the National Cancer InstituteIdentified Enrollment Challenges of Adolescent and Young Adult Patients on the Nonchemotherapy Arm of Children's Oncology Group Study ARST1321
2022, Journal of Adolescent and Young Adult Oncology
Financial disclosures and conflicts of interest: none declared.
Supported in part by U10 CA180886 (ARW), U10 CA98543 (DRF), U10 CA180888 (CRN), and the Aflac Foundation (DRF).