Adolescents and young adults with cancer - The scope of the problem and criticality of clinical trials
Adolescents and young adults with cancer - The scope of the problem and criticality of clinical trials
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DOI：
10.1002/cncr.22102
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发表时间：
2006-10-01
期刊：
影响因子：
6.2
通讯作者：
Montello, Michael
中科院分区：
文献类型：
--
作者：
Bleyer, Archie;Budd, Troy;Montello, Michael
在美国，与年轻或年长的患者相比，年龄较大的青少年和患有癌症的年轻人从治疗进步中受益较少。可能解释这一缺陷的一个因素是，这个年龄段的患者相对缺乏参与可以改善其结果的治疗的临床试验。比较了美国癌症患者参与临床试验的情况，作为患者年龄的函数，与全国癌症死亡率的变化；以及监测，流行病学，最终结果(SEER)癌症存活率作为年龄函数的比较。在15-34岁的患者中，癌症治疗试验的参与率明显低于年轻或老年患者。在所有主要族裔和种族群体中，男性和女性的最低点都很明显。全国癌症死亡率的降低和SEER生存率的提高显示出类似的年龄依赖性。在美国，癌症治疗试验参与率的年龄依赖性，以及生存期延长和癌症死亡率的改善是相关的。无论是否存在因果关系，癌症对美国青春期和青壮年人口的影响都是巨大的，对全国医疗保健成本、人的寿命损失、年轻人进入就业市场的损失以及青春期和成年期早期癌症的科学知识和社会影响都产生了不利影响。目前正在采取国家举措来解决这些问题，特别强调增加为年长青少年和年轻人设计的临床试验的可获得性和可及性。
In the U.S., older adolescents and young adults with cancer have benefited less from therapeutic advances than did either younger or older patients. One factor that may explain this deficit is the relative lack of participation of patients in this age group on clinical trials of therapies that could improve their outcome. Comparisons were made of the participation of cancer patients on clinical trials in the U.S., as a function of patient age, with the change in national cancer mortality rate; and Surveillance, Epidemiology, End Results (SEER) cancer survival rate as a function of age. The participation rate in cancer treatment trials has been strikingly lower in 15-34-year-olds than in younger or older patients. The nadir has been apparent for both males and females in all of the major ethnic and racial groups. The national cancer mortality reduction and SEER survival improvement shows a similar age dependence. In the U.S., the age-dependence of cancer treatment trial participation, and of improvement in survival prolongation and cancer death rates, are correlated. Regardless of whether there is a causal relationship, the impact on the older adolescent and young adult U.S. population is substantial, adversely affecting the national cost of healthcare, the person-years of life lost, the loss of young people entering the job market, and the scientific knowledge and social implications of cancer during adolescence and early adulthood. National initiatives are underway to address these issues, with special emphasis on increasing the availability and access to clinical trials designed for older adolescents and young adults.