The management of cancer in the older adolescent K. Albritton a,1 , W.A. Bleyer b, * a Huntsman Cancer Institute, University of Utah, USA b The University of Texas M. D. Anderson Cancer Center, The University of Texas Medical School –– Houston, USA Received 25 May 2003; received in revised form 5 September 2003; accepted 11 September 2003 Abstract Cancer in adolescents 15–19 years of age occurs at nearly twice the rate observed in 5- to 14-year-olds, but as of yet they have no explicit organisation for research and care, such as that structured for younger paediatric patients. Adolescents with cancer must be recognised as a subgroup of oncology patients with specific characteristics and needs requiring dedicated interest and management. The need is made most evident as outcome data indicates that adolescents are lagging behind in survival gains made in recent decades by both children and adults with cancer. Improvements in the overall survival, quality of care and quality of survival of adolescents with cancer will only occur by surmounting the challenges, discussed in this review, unique to this group of patients. # 2003 Elsevier Ltd. All rights reserved. Keywords: Cancer; Adolescents; Young adults 1. Introduction The rate of 5-year survival improvement in children and in adults 45 years of age and older, shown in Fig. 1 for the 1975–1998 era in the United States (U.S.), has averaged a steady and remarkable 1.74% per year for patients of all ages with invasive cancers. However, among adolescents 15–19 years of age, the improvement has been nearly 50% less, at 0.91% per year (Fig. 1) [1]. With the types of cancer that older adolescents develop, their overall survival was better, in the 1970s and 1980s, than in children and younger adolescents. The relative lack of progress has led to worse outcome, such that during the 1990s, the survival of 15- to 19-year-olds fell behind that in younger patients (Fig. 2). In the U.S., Europe, and most socio-economically advantaged countries, cancer develops in more patients between 15 and 20 years of age than between either 5 and 10 or 10 and 15 years of age. Yet, few, if any, countries have nationally organised programmes to address their special problems, including the relative lack of progress in their outcome. Reasons for this lack of progress are certainly numerous and multifactorial. They include issues spe- cific to this age group: some are inherent in the disease or the patient (differences in biology or intolerance of therapy), some are inherent in the system (treatment by physicians less familiar with the disease, delay in recog- nition of malignancy, lack of available clinical trials), and others are influenced by the psychosocial milieu of the patient (lack of medical insurance and financial resources, delays in seeking medical attention with symptoms of cancer, poor compliance with treatment, unwillingness to participate in clinical trials). A further consideration is that the physical, emotional and social challenges posed by cancer in adolescence and early adult life are often unique and especially difficult for patients, families and healthcare providers alike; these needs remain largely unstudied and unmet. This review considers the scope of the problem by reviewing the incidence and mortality burden of cancer in the adolescents, the unique distribution of cancers and the concerning lack of improvement in survival. We then address those issues that make management of this population of oncology patients unique and challen- ging. The goal is to heighten awareness of a relatively neglected group of patients and improve their recogni- tion, management and outcome. The focus will be on patients in the 15- to 19-year age group, notwithstand- ing the likelihood that many of the principles are 0959-8049/$ - see front matter # 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2003.09.013 European Journal of Cancer 39 (2003) 2584–2599 www.ejconline.com * Corresponding author. Anderson Cancer Center, Division of Cancer Medicine, Box 421, 1515 Holcombe Blvd., Houston TX 77030, USA. Tel.: 713-792-8516; fax: 713-794-1807. E-mail address: ableyer@mdanderson.org (W.A. Bleyer). 1 Children’s Oncology Group.