Cancer is uncommon in adolescents but has become the leading cause of disease-related death in high-income countries. It is surpassed by infectious diseases in low and middle-income countries, however survival rates for children and adolescents with cancer are up to 60% lower in African low-income countries where the median age of the population ranges from 15 to 19 years. Adolescence is a time of major physical, physiological, cognitive and social development. Searching for identity and asserting independence all adds to the challenge of treating cancer in this group. Age appropriate environment and expertise is required to navigate the divide between paediatric and adult oncology. This transition is best facilitated in a coordinated fashion to ensure care through the continuum from diagnosis to survivorship. Variation in healthcare systems and infrastructure precludes the use of a standardised approach to managing adolescents with cancer. This session will identify the essential stakeholders needed for multidisciplinary clinics, look at using shared protocols to manage common cancers seen in childhood and adolescence, and explore ways to manage patients across the age spectrum. Practical chemotherapy-related questions like dose considerations, late effects and fertility issues in adolescents will be discussed. A supportive patient-provider relationship has been shown to be essential for adolescents’ perception of quality care. This may present an obstacle in the transition to adult care as they are reluctant to switch from the caring environment provided by the paediatric oncology service to the overburdened and often under-resourced adult oncology service. A step-wise approach may alleviate this problem but relies on good cooperation between paediatric and adult cancer care providers. The population of childhood and adolescent cancer survivors is steadily increasing worldwide thus comprehensive survivorship programs are paramount.

Modern radical cancer therapy is tailored to provide the best chance of cure whilst limiting late side-effects. Historically radiotherapy was the most successful modality in the treatment of childhood cancers, however it’s use has declined considerably over the past 40 years due to adverse effects. Improved survival rates seen over the same period has been attributed to advances in chemotherapy, use of combination therapy, enhanced risk stratification and improvements in surgical and radiotherapy techniques. Radiotherapy is an invaluable tool in the palliative care setting. Adolescent and young adult cancer survivors demonstrate an increased mortality from secondary malignancies and non-cancer-related causes compared to the general population. The excess morbidity and mortality noted in this group persists lifelong. Physical and endocrine maturation during adolescence must be considered when planning radiotherapy to ensure that cancer survivors attain pubertal milestones and develop to their full potential with minimal sequelae. Modern radiotherapy techniques have resulted in superior dose distribution and reduced dose to normal structures. Good pre-treatment imaging is essential for accurately determining radiotherapy target volumes. All relevant organs at risk should be properly contoured and internationally accepted normal tissue complication guidelines like Quantec utilised to minimise late effects. Where less sophisticated radiotherapy planning and treatment techniques is all that is available, it is still crucial to plan wisely to limit late effects. We shall review the radiotherapy-induced late effects on various organ systems and examine the interplay between the various treatment modalities in the evolution of some of these late effects. Preservation of reproductive function and fertility is of great concern to adolescents undergoing cancer treatment. Adolescent cognitive development and behavioural issues must be considered when planning and consenting for radiotherapy to ensure compliance.

Applying often accepted age range of 15–39 years, there are approximately 3 billion adolescents and young adults (AYA) living in the world today, an estimated 1 million of whom will develop cancer; many without access to diagnosis or treatment1. In countries with younger populations there is a higher cancer burden, and implications for the present and future economy as AYA form a key component of the working population and care for younger and older generations. The ability of care providers to assist AYA with cancer varies dramatically from continent to continent, regardless AYAs with cancer are often treated less comprehensively than children and older adults, nor is the evidence base, knowledge and scientific understanding of their cancer as robust; with a corresponding lack of improvement in survival rates 2. This age group includes individuals who may be particularly complicated to care for, with varying levels of maturity, and specific socio-psychological needs. In terms of health care delivery, it has become apparent that AYA patients are at best placed in neither paediatric nor adult cancer services and with consequences in terms of the quality of care and outcome. Recently the cancer community has become aware of these gaps and AYA cancer programmes are being formed in an attempt to address them and the unmet needs of this age group. These programmes navigate the obstacles of culture, physical space, and provider expertise in the attempt to achieve an improvement in outcomes. Among the most important factors for the successful establishment of these programmes are the degree of engagement of paediatric and adult clinicians, the philanthropic support of powerful charities, and the role of dedicated professionals across a range of disciplines2. This presentation discusses how these issues were addressed to develop an organizational model of care using a patient-focused multidisciplinary approach. How similar models have evolved in other countries to suit local health and social care systems and how collectively a comprehensive, multipronged effort to bridge the gaps in the care of AYA cancer patients is emerging as a new global cancer discipline.
ACKNOWLEDGMENTS Bleyer, A., Ferrari, A., Whelan et al 2017. Global assessment of cancer incidence and survival in adolescents and young adults. Pediatric blood & cancer, 64(9), p.e26497. Ferrari, A., Thomas, D., Franklin, A et al 2010. Starting an adolescent and young adult program: some success stories and some obstacles to overcome. Journal of Clinical Oncology, 28(32), pp.4850-4857.