Cancer services: Adolescents with cancer need a different treatment approach in order to improve their survival rate, a leading cancer specialist has said.
Prof Owen Smith, professor of haematology at Trinity College Dublin and a consultant paediatric haematologist at Our Lady's Hospital for Sick Children, in Crumlin, Dublin, called for a dedicated cancer treatment facility in the Republic for adolescents and young adults, aged 16 to 21.
Giving the annual St Luke's Lecture at the Royal Academy of Medicine in Ireland, Prof Smith said: "Cancer services are delivered by an out-of-date infrastructure that, by and large, fails adolescents."
Among the reasons for this was late diagnosis, a low rate of entry of adolescent patients into clinical trials, and the division of child and adult services. In addition, different treatment protocols are used for the same disease in adolescents.
"Adult cancer services are based on the specific site of a cancer while paediatric services use a generic, multidisciplinary team approach," he said.
Pointing out that adolescents prefer to be treated among their peers, and that this helps improve compliance with lengthy treatment, Prof Smith said adolescents were also more compliant when their care involved their parents. He also said that acute leukaemia was an example of how cancer treatment in adolescents could be improved.
The treatment outcome of children with acute lymphoblastic leukaemia (ALL), in which immature lymph cells take over the bone marrow, has risen from 20 per cent to 85 per cent over the past 40 years. But adolescents aged 16 to 21, have a survival rate that falls short of cure rates in children, he said.
"However, if you take patients aged 16 to 21 years with ALL and treat some with adult and some with paediatric protocols, there is a significant benefit for those treated with a paediatric protocol."
In a French study, almost 70 per cent of adolescents with ALL survived for five years using the paediatric approach, compared with a 41 per cent survival rate for those treated using adult guidelines.
And a more recent UK/Irish study showed a 65 per cent cure rate for those adolescents treated with a paediatric protocol compared with a 50 per cent cure rate for those given the adult treatment. Another example of the need for a dedicated adolescent approach was Ewing's sarcoma, a form of bone cancer.
Prof Smith said: "Adolescents and young adults with Ewing's sarcoma had a statistically better outcome when they were treated at paediatric centres, rather than adult centres, even when they got the same drug regimen. This shows the impact of psychosocial factors."
Calling on the Health Service Executive to provide a dedicated adolescent cancer facility in the State, Prof Smith said the upcoming redevelopment of Crumlin hospital would be an ideal time to consider a purpose-built centre for adolescents.
"As we learn more about the details of cancer at the molecular genetic level, I believe we will cure more adolescents with the disease. In the meantime we should be more concerned with simplifying cancer treatment for this age group," he said.
"The best way to do this is to treat them in an age-appropriate facility with multidisciplinary teams. This approach will cost very little but the return will be large in terms of cancer cures," he said.