Cancer in Young Adults is preventable | Sunday Observer

Cancer in Young Adults is preventable

The age group in between children and adults where cancers are commonly seen
The age group in between children and adults where cancers are commonly seen

Cancer in young adults and adolescents is an emerging health risk. Yet, this is an area that seems to have been sidelined by researchers and public health officials. Unless addressed with the right approach, taking into account the sensitivities of this vulnerable group, the world as a whole, including Sri Lanka, stands to lose one of the most important and precious segments of our society – young people whose lives have been lost needlessly. These young adults are a unique group. Teetering at the edge of adolescence that brings with it hormonal changes and inexplicable mood swings as they still struggle to overcome their childhood fears, their specific problems need specialised persons from paediatricians, psychiatrists, psychologists and counsellors willing to spend time to listen to them and talk to their parents to encourage parental support.

A specialist in the field who has persistently championed their cause, Consultant in Paediatric and Adolescent Oncology, Dr. Sanjeeva Gunasekera shared his insights with the Sunday Observer, into this unique age group drawing from his own personal hands on experiences with adolescents afflicted by cancer.

Excerpts …

Q. Cancer is said to be the leading cause of disease-related death in the Adolescent and Young Adult population (AYA). Explain what AYA cancers are.

A. AYA is the age group in between children and adults. This is a unique age group where cancers are commonly seen in children as well as adults. There is also the question whether they should be treated using paediatric or adult treatment protocols. (There is increasing evidence to suggest they do better when paediatric protocols are used.) However, there is no universal agreement as to what age group is defined as AYAs. Some say it is 14-24 but some have expanded it to 14-39 years.

Q. Will there be more AYAs with cancer compared to younger children in the future? What is the Lankan scenario?

A. There will definitely be more AYAs with cancer compared to younger children. In Sri Lanka according to the National Cancer Incidence data of 2010 published by the National Cancer Control Program there were 458 children 0-14 years diagnosed with cancer whereas the figure for AYAs aged 14-39 was 1,857.

Q. Why are AYAs more vulnerable to cancer than children?

A. Generally, cancer incidence increases with age, i.e. the older you are the higher the risk. This makes the AYA group more vulnerable to cancer than children. However, compared to older adults AYA cancer risk is much less.

Q. What are the most common cancers in AYAs?

A. This age group is a transition period between childhood and adulthood where you see a mix of children’s cancers as well as adult cancers. Lymphomas and Leukaemias are still the most common cancer, especially, Hodgkin Lymphoma has a higher incidence in this age group. Bone tumours like Osteosarcomas and Ewing sarcomas are also common. A type of cancer arising mainly in the ovaries or testis called Germ Cell Tumours is also a significant cancer in this age group. Adult cancers like Thyroid cancers and Breast cancers are now becoming increasingly more common.

Q. You said specific cancer types increase with age. Why is this?

A. As you grow older ‘adult’ cancers take over. A possible reason for this is, you would get more exposed to cancer causing agents in the environment, food, workplace etc as you get older and this could result in higher cancer incidence in older people.

Q. The effect of treatment on fertility is a special concern for young cancer patients. What is your advice to young women with cancer who want to start a family?

A. When treating cancers in this age group preserving fertility is of utmost importance. Most times they are advised not to get pregnant while on active treatment. This is because the medications used can have a detrimental impact on the unborn child. The choice of chemotherapy protocols are also made to minimize the impact on fertility. However, sometimes unfortunately, due to the site of the tumour, side effects of treatment and biology of the cancer their fertility might be impaired. In this case they are advised to seek medical advice when they are ready to have children and there are several interventions available to help them in this process.

Q. Can you inherit cancer ?

A. Like all cancers genetics play an important part. Some of these genetic changes are inherited while others spontaneously occur after you are born. Some inherited genetic disorders become evident when several members of the same family develop cancers. They usually develop these cancers at a younger age compared to the general population. Some cancers that can have a hereditary genetic component are breast cancers, colon cancers, ovarian cancers etc. If such a genetic change in a family is identified the other family members should also be tested and be under close observation to detect early signs of cancer.

Q. If detected early can they be prevented?

A. This again applies to all groups of cancers. Earlier the detection better the chance of a complete cure. If the patient presents after it has spread to many parts of the body, the possibility of a cure is remote. This highlights the importance of cancer screening, especially, in those vulnerable.

Q. How do you treat Adolescent and Young Adult patients? What are their options?

A. As oncologists we have three main weapons to fight cancers. They are surgery, chemotherapy and radiotherapy. When treating these patients all three of these modalities can be utilized. The decision as to which modality would play the leading role would depend on the type of cancer. The patients’ wishes also carry weight in the selection.

Q. When dealing with cancer, what are the problems unique to the AYA group?

A. Even for healthy children, 15 – 25 years is an age where many changes happen physically, mentally and socially. Children with cancer in this group would have to deal with these changes in addition to cancer and everything that comes with it. This can be extremely challenging. This is an age where they are conscious of the body image. Cancer and its treatment can cause many changes in their physical appearance. This can come as a big shock to them, so much so, they could sometimes refuse treatment even when they know it would result in a significant threat to their lives. Therefore, they need a lot of support to get through these troubling times. A patient hearing of their concerns and addressing them in a manner they can understand could help them face these challenges, better.

Q. Young people with cancer say it’s especially helpful to connect with other young people and share insights based on their own experiences. Do you agree?

A. Young people would always prefer to associate with their peers. For them information gathered from these peers can have a lot of credibility and acceptability. Therefore, connecting with other young people who have gone through cancer treatment and overcome all the challenges can have a great impact on newly diagnosed cancer patients of same age. The fact that they have overcome cancer can give them courage to face their own illness.

Q. Once treatment is completed, while many survivors believe it is something to celebrate, others believe there are more difficult challenges.Your comments?

A. It is indeed a time to celebrate. They have gone through much hardship to achieve this. However, they need to be closely monitored not only for early signs of their cancer coming back but also to see whether they develop any long term side effects of their treatment. Also during their treatment phase their education, social interactions, personal development etc might have been curtailed. Therefore, the onus must be placed on helping them to get back to their normal lives in a structured way. Cancer survivors also suffer due to some wrong beliefs of society. They must be empowered to successfully face these challenges. The ultimate goal of treating a cancer patient is not only to cure the cancer but ensure they would lead as normal a life as possible.

Q. Are there any ongoing research studies on AYA oncology in Sri Lanka?

A. As the present research output is not satisfactory, the Sri Lanka College of Oncologists recently launched the Sri Lanka Cancer Research Group. This group hopes to coordinate local research into cancer, provide logistical support and improve quality cancer research in Sri Lanka identifying AYA cancer as a priority area.

Q. Gaps in the delivery of quality care for Lankan young adults and adolescents with cancer?

A. AYA patients are a different group of patients with their unique needs. But often they are grouped with children or adults. It would be best if they can be cared for in their own ward which can be customized to meet their needs. They would need a lot of psychosocial support to get through this difficult phase. Counsellors and social workers can play an important role in this regard. They are not freely available in the local hospital system. Although during treatment interruptions to their education or occupational activities cannot be avoided all efforts need to be made to minimize the impact of these interruptions. Employing teachers in hospitals, continuing a suitable vocational training while having treatment are some of the interventions we can use to minimize the impact.

Q. The current trend of eating junk food and fast foods, has been blamed for the rise of several Non Communicable Diseases ( NCDs) Has our unhealthy diet and lifestyles anything to do with the rise of cancer in AYAs?

A. There is evidence to suggest that processed foods, some chemicals used as food preservatives, obesity etc can increase the risk of various cancers. Therefore, as in all other age groups unhealthy lifestyles can have an association with increasing cancer incidence in this age group as well.

Q. Your message to the young people who are potential patients of AYA cancers ?

A. Cancer like any other disease can afflict anyone. Most times you would get this disease due to no fault of yours. If detected early most of these cancers can be cured. Therefore, it is important to follow the treatment regimen prescribed as closely as possible. This would give you the best chance for a complete cure. Remember the physical changes you undergo due to the disease and the treatments are temporary. Putting up with them is completely worth it when you consider the end result. Remember after treatment is completed it is most likely that you would have a long period of time ahead of you. Therefore, don’t completely put your life on hold while on treatment. Continue to do whatever activities that can be done. This would help you to bounce back and lead a normal life when treatment is completed.