Using Teamwork to Bridge the Adolescent and Young Adult Gap.

Abstract

Individuals diagnosed with cancer age between 15 and 39 years (adolescents and young adults [AYAs]) have not seen improvement in survival compared with children or older adults; clinical trial accrual correlates with survival. Unique unmet needs among AYAs related to psychosocial support and fertility preservation (FP) are associated with health-related quality of life. We enhanced existing structures and leveraged faculty/staff across pediatric/adult oncology to create novel teams focused on AYA (age 15-39 years) care at a single center, with minimal dedicated staff and no change to revenue streams. We aimed to influence domains shown to drive survival and health-related quality of life: clinical trial enrollment, physician/staff collaboration, psychosocial support, and FP. We captured metrics 3 months after patients presented to the institution and compared them before/after Program implementation using descriptive statistics. Among 139 AYAs (age 15-39 years) from the pre-Program era (January 2016-February 2019: adult, n = 79; pediatric, n = 60), and 279 from the post-Program era (February 2019-March 2022: adult, n = 215; pediatric, n = 64), there was no change in clinical trial enrollment(<i>P</i> ≥ .3), whereas there was an increase in the proportion of AYAs referred for supportive care and psychology (pediatric: <i>P</i> ≤ .02; adult: <i>P</i> ≤ .001); whose oncologists discussed FP (pediatric: 15% <i>v</i> 52%, <i>P</i> < .0001; adult: 37% <i>v</i> 50%, <i>P</i> = .0004); and undergoing FP consults (pediatric: 8% <i>v</i>39%, <i>P</i> < .0001; adult 23% <i>v</i> 38%, <i>P</i> = .02). This team-based framework has effected change in most targeted domains. To affect all domains and design optimal interventions, it is crucial to understand patient-level and facility-level barriers/facilitators to FP and clinical trial enrollment.