Adolescent urologic oncology: Current issues and future directions, "Beyond the Abstract," by Nicholas G. Cost, MD

BERKELEY, CA (UroToday.com) - Adolescents with cancer represent a unique group since they may seek care with either pediatric or adult oncologic specialists. These patients also have unique needs compared with children and adults related to transition to adult centers, common relocation for education or vocation, and emerging independence from parents. In our article, we highlight the growing issue of adolescent patients with urologic malignancies and frame this population within the emerging field of adolescent oncology in general. While raising awareness through an overview of such oncologic diagnoses in this population as testicular cancer, renal malignancy, and the various genitourinary rhabdomyosarcomas is of benefit to both adult and pediatric urologists, the most important part of our article was to highlight the unique needs of these patients. For example, issues such as fertility, radiation exposure during therapy and surveillance, risk of secondary malignancy, the long-term impacts of chemotherapy, and the psychosocial burdens of malignancy on this population.

While it is less publicized than pediatric oncology, there are actually more adolescents diagnosed with urologic malignancies each year than children, and currently the outcomes for these patients are worse than either their pediatric or adult counterparts. Thus, one main focus of our work is to raise awareness. While there may be a number of factors at play, the fact that these patients are often “caught in-between” the adult and pediatric medical worlds certainly contributes to this group of patients “falling through the cracks.” Thus, we specifically highlight how each of these diagnoses vary for adolescents as opposed to children and adults. Continuing this line of thinking, we are strongly encouraging the continued growth of adolescent oncology as its own field of medicine so that these patients can receive the necessary, specialized care. In addition, this requires multi-disciplinary and multi-modal approaches utilized in both pediatric and adult cancer specialists. This extends to the need for increased clinical trial participation in this population. Currently, the rates of enrollment are significantly lower than those of their pediatric counterparts, even for the same disease processes.

In summary, our work reviews the most common adolescent urologic cancer diagnoses, such as testicular cancer, the second peak of the bimodal age distribution of genitourinary rhabdomyosarcoma, and adolescent renal malignancies. In doing so, we focus on how the pathology and management of these diseases vary from either their adult or pediatric counterparts and specifically mention the surrounding issues of fertility, the social impact of therapy, and the psychosocial burdens on this population. The most important future needs for this field of urologic oncology include:

  1. continued education and awareness of adolescent urologic oncology,
  2. identifying what areas of research will directly lead to increased survival or improved quality of life in adolescents,
  3. increasing funding opportunities to investigators interested in adolescent cancer, and
  4. closing the current gap in clinical trial participation.

This is an exciting time as the field of adolescent urologic oncology develops; we feel that with increasing specialization and attention, the outcomes for this population can and will improve to make it the ideal example of multi-disciplinary oncology management.

Written by:

Nicholas G. Cost, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

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Cincinnati Children’s Hospital Medical Center
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Adolescent urologic oncology: Current issues and future directions - Abstract

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