Showing posts with label Teenage. Show all posts
Showing posts with label Teenage. Show all posts
Tuesday, March 1, 2011
Teenage and Young Adult cancer treatment consultation
The UK Department of Health is conducting the following until 11 April:
Thursday, March 29, 2007
UKALL 2003 - Young Adults II
The UKALL 2003 protocol has a Young Adult Appendix which elaborates on research into adult versus paediatric treatment regimes for young adults where it is stated that in the past "adolescents have received ALL therapy according to either paediatric or adult clinical trials, determined only by local referrals to paedatric or adult physicians". GPs decide the treatment protocol? Oh dear. Dr John - you have to decide a young adult's ALL treatment!
Fortunately, for Lucia and H., they have been put on the UKALL 2003 (paediatric) trial. Why?
Various treatment protocols in trials in several countries have found that pediatric protocols are more effective for young adults than adult protocols (the stats are on p. 128 of the protocol) . Evidence from previous UKALL trials and overseas trials is not conclusive yet but the Event Free Survival (EFS) rates and Overall Survival (OS) rates seem to be better for young adults receiving paediatric as opposed to adult treatment.
The evidence is not considered to be conclusve by the medical profession as sampling (i.e.patients) has not been sufficient, but it is strong enough to comsider further testing.
So an aim, albeit not the principle one, of the UKALL 2003 Trial is to evaluate the use of a slightly modified paediatric regime in young adults.
Differences between young adults and adults at prognosis do not seem to be important. However, there are major differences in treatment regimes.
UKALL 2003 is slightly modified for young adults. Children are first evaluated into risk groups at Day 8 when Slow Early Responders are automatically put on Regimen C. However, the USCCG 1882 trial showed no benefits to this for young adults with "normal" ALL (i.e. with no complications arising from genetic defects who automatically go onto Regime C). At Day 28 Mean Residual Disease High Risk young adults are randomised between Regimes B (with two Delayed Intensification phases) and C. Low Risk patients follow Regime B with randomisation between one and two Delayed Intensifications. No young adults follow Regime A, I assume because their age does put them at higher risk than children.
So, although the Royal Manchester Children's Hospital does not have a young adult unit as Manchester's other cancer hospital does, at RMCH you do get the advantage of following the paediatric UKALL 2003 protocol whilst at Christies you follow the adult UKALL XII protocol.
And all the more reason that the new RMCH should have a young adult unit.
And the message to the referrers is send your ALL young adult patients to a paediatric hospital.
Disclaimer: I should reiterate that this applies to T-cell ALL, not B-cell that goes on another procotol that I know nothing about, and certainly not other forms of leukeamia.
Fortunately, for Lucia and H., they have been put on the UKALL 2003 (paediatric) trial. Why?
Various treatment protocols in trials in several countries have found that pediatric protocols are more effective for young adults than adult protocols (the stats are on p. 128 of the protocol) . Evidence from previous UKALL trials and overseas trials is not conclusive yet but the Event Free Survival (EFS) rates and Overall Survival (OS) rates seem to be better for young adults receiving paediatric as opposed to adult treatment.
The evidence is not considered to be conclusve by the medical profession as sampling (i.e.patients) has not been sufficient, but it is strong enough to comsider further testing.
So an aim, albeit not the principle one, of the UKALL 2003 Trial is to evaluate the use of a slightly modified paediatric regime in young adults.
Differences between young adults and adults at prognosis do not seem to be important. However, there are major differences in treatment regimes.
UKALL 2003 is slightly modified for young adults. Children are first evaluated into risk groups at Day 8 when Slow Early Responders are automatically put on Regimen C. However, the USCCG 1882 trial showed no benefits to this for young adults with "normal" ALL (i.e. with no complications arising from genetic defects who automatically go onto Regime C). At Day 28 Mean Residual Disease High Risk young adults are randomised between Regimes B (with two Delayed Intensification phases) and C. Low Risk patients follow Regime B with randomisation between one and two Delayed Intensifications. No young adults follow Regime A, I assume because their age does put them at higher risk than children.
So, although the Royal Manchester Children's Hospital does not have a young adult unit as Manchester's other cancer hospital does, at RMCH you do get the advantage of following the paediatric UKALL 2003 protocol whilst at Christies you follow the adult UKALL XII protocol.
And all the more reason that the new RMCH should have a young adult unit.
And the message to the referrers is send your ALL young adult patients to a paediatric hospital.
Disclaimer: I should reiterate that this applies to T-cell ALL, not B-cell that goes on another procotol that I know nothing about, and certainly not other forms of leukeamia.
Tuesday, March 27, 2007
UKALL 2003 - Young Adults
Lucia draws my attention to the fact that in latest version of the UKALL 2003 (posted February 2007 - link on right) has now increased the age range eligibility to 19 + 364 days. The protocol has a Young Adult Appendix which elaborates on research into adult versus paediatric treatment regimes for young adults - next post.
Monday, March 26, 2007
Young Adult Oncology Units
And the previous post leads onto ...
Putting a young adult with cancer into a bed next to a 70-year old or a 2-year old (Kezia) just ain't going to work. Psychologically it is just not a happy mix. Not for any of them. The only thing any of them has got in common is cancer.
There have been studies that putting young adults onto a pediatric treatment regime (and hence pediatric ward) will improve their prognosis. The decision to put you on the UKALL 2003 trial protocol agewise is pretty arbitrary - if you are diagnosed before you're 16th birthday (15 + 364 days), then you are eligible. But I suppose there has to be a cut-off somewhere.
The Teenage Cancer Trust has financed seven oncology treatment units for young adults and aims to finance fifteen more. In Manchester only Christies Hospital has one. Read about them here. And watch a video.
Unfortunately, for Lucia and H. the Royal Manchester Children's Hospital doesn't have one and even at the new children's hospital there are no plans for one. Which seems a bit absurd to me if young adults are going to be referred there.
Putting a young adult with cancer into a bed next to a 70-year old or a 2-year old (Kezia) just ain't going to work. Psychologically it is just not a happy mix. Not for any of them. The only thing any of them has got in common is cancer.
There have been studies that putting young adults onto a pediatric treatment regime (and hence pediatric ward) will improve their prognosis. The decision to put you on the UKALL 2003 trial protocol agewise is pretty arbitrary - if you are diagnosed before you're 16th birthday (15 + 364 days), then you are eligible. But I suppose there has to be a cut-off somewhere.
The Teenage Cancer Trust has financed seven oncology treatment units for young adults and aims to finance fifteen more. In Manchester only Christies Hospital has one. Read about them here. And watch a video.
Unfortunately, for Lucia and H. the Royal Manchester Children's Hospital doesn't have one and even at the new children's hospital there are no plans for one. Which seems a bit absurd to me if young adults are going to be referred there.
Teenage
As a "teenager", I definitely was not a child. As a teenager, everything was new. And more often than not unexpected. What had changed?
Primary school to secondary school. Learning basic skills (reading, writing, arithmetic) to the more academic (History, Biology, Mathematics, Geography, French etc) . Independence, often fought for. Curiosity. Cigarettes, alcohol, cannabis, music (I was 15 when "Anarchy in the UK" hit the streets), "rebellion" against my parents' "norms". Puberty and consciousness of sex and anxiously wanting it but never "doing" it. Underage drinking on Friday and Saturday nights, Saturday and holiday job - the boss, Kate, was formidable but took me (hung-over) at 6:30 am under her wing.
Consciousness that I am "me", that I am "Angus". That I have an identity. That I am unique.
I cannot imagine my parents' generation when you could be in the factory from 14, or my grandparents' generation when it was even younger; Where I'm talking from, whether you are male or female, since year dot you may be working, and you may be a parent as soon as you hit puberty and have to be responsible for someone else. You are an adult.
And that is perhaps an important difference between childhood and adulthood. However, in the "developed world" I was not, yet, considered to be useful, I was not yet somehow adult. I was in a limbo between child and adulthood that has become known as "teenage". So I want to stop using "teenage" now and talk about young adults.
What else changed?
Cancer.
Nope.
Learning I might die?
Nope.
But for 2200 people per year (just) in the U.K. that is part of the above formula, of being a young adult.
Rob, in Siblings II, wonders what Fergus (aged 7) understands about his leukaemia and concludes "not much", the treatment is something to be got through. Kezia has even less understanding.
As a young adult, just when you are learning the ropes of being adult, learning about sex, birth and death and much else, then learning your own mortality, understanding that you may die and soon, must be pretty rough.
Lucia and H. and Josie Grove understand.
Primary school to secondary school. Learning basic skills (reading, writing, arithmetic) to the more academic (History, Biology, Mathematics, Geography, French etc) . Independence, often fought for. Curiosity. Cigarettes, alcohol, cannabis, music (I was 15 when "Anarchy in the UK" hit the streets), "rebellion" against my parents' "norms". Puberty and consciousness of sex and anxiously wanting it but never "doing" it. Underage drinking on Friday and Saturday nights, Saturday and holiday job - the boss, Kate, was formidable but took me (hung-over) at 6:30 am under her wing.
Consciousness that I am "me", that I am "Angus". That I have an identity. That I am unique.
I cannot imagine my parents' generation when you could be in the factory from 14, or my grandparents' generation when it was even younger; Where I'm talking from, whether you are male or female, since year dot you may be working, and you may be a parent as soon as you hit puberty and have to be responsible for someone else. You are an adult.
And that is perhaps an important difference between childhood and adulthood. However, in the "developed world" I was not, yet, considered to be useful, I was not yet somehow adult. I was in a limbo between child and adulthood that has become known as "teenage". So I want to stop using "teenage" now and talk about young adults.
What else changed?
Cancer.
Nope.
Learning I might die?
Nope.
But for 2200 people per year (just) in the U.K. that is part of the above formula, of being a young adult.
Rob, in Siblings II, wonders what Fergus (aged 7) understands about his leukaemia and concludes "not much", the treatment is something to be got through. Kezia has even less understanding.
As a young adult, just when you are learning the ropes of being adult, learning about sex, birth and death and much else, then learning your own mortality, understanding that you may die and soon, must be pretty rough.
Lucia and H. and Josie Grove understand.
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