19th January 2018, Volume 131 Number 1468

Kirsten Ballantine, Victoria Utley, Heidi Watson, Michael Sullivan, Ruth Spearing

Adolescent and young adult (AYA) oncology is described as “the interface of paediatric and adult oncology”.1 A diverse range of cancers affect this age group, including cancers such as acute…

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Summary

Due to our small population and geographic spread, New Zealand faces unique challenges in providing high-quality, comprehensive adolescent and young adult (AYA) cancer services. A 2000–2009 15–24-year analysis showed poorer survival for Māori and Pacific Peoples and for AYA diagnosed with certain cancers such as bone tumours. This has led to a major national focus to improve the outcomes for our AYA population, including the establishment of the AYA Cancer Network Aotearoa in 2013 and the release of the AYA Standards of Care in May 2017. In this paper we report a comprehensive analysis of the incidence and outcome for 25–29 year-old cancer patients. In addition, this paper introduces the AYA Cancer Network and provides the New Zealand medical community with an overview of some the current issues in AYA oncology, including the lack of a clear AYA age range and barriers to increasing clinical trial participation rates for this at-risk population.

Abstract

Aim

New Zealand currently defines the adolescent and young adult (AYA) group for cancer services as young people 12–24 years of age, while other countries favour a designation of 15–29 years. This study was undertaken to compare cancer incidence and survival among 25–29 year olds to New Zealand’s younger AYA population and to assess survival for our 15–29 year population against international benchmarks.

Method

Diagnostic and demographic information for cancer registrations between 2000 and 2009 for 25–29 year olds was obtained from the New Zealand Cancer Registry. Incidence rates (IR) and five-year relative survival estimates were calculated according to AYA diagnostic group/sub-group, sex and prioritised ethnicity.

Results

1,541 new primary malignant cancers were diagnosed (IR: 588 per million). Five-year relative survival was 85%, but was significantly lower for Māori and Pacific peoples (both 77%) compared to non-Māori/non-Pacific peoples (88%). In the overall 15–29 year AYA cohort, disease-specific outcomes for bone tumours (46%) and breast cancer (64%) were inferior to international standards.

Conclusion

New Zealand 25 to 29 year olds are at twice the risk of developing cancer as those 15–24 years. Given that the survival disparities identified were remarkably consistent with those for younger AYA, consideration should be given widening New Zealand’s AYA age range.

Author Information

Kirsten R Ballantine, Analyst, National Child Cancer Network, Christchurch;
Victoria Utley, House Officer, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga;
Heidi Watson, Clinical Lead, AYA Cancer Network Aotearoa, Auckland;
Michael J Sullivan, Paediatric Oncologist, Children’s Cancer Centre, the Royal Children’s Hospital, Melbourne, Australia and Professor, Department of Paediatrics, University of Otago, Christchurch;
Ruth Spearing, Haematologist, Christchurch Hospital, Canterbury District Health Board, Christchurch.

Acknowledgements

This study was completed as part of a University of Otago/Canterbury District Health Board Summer Studentship Project. We thank the Cancer Society of New Zealand Canterbury-West Coast Division & Rangiora Group as the project sponsor and the National Child Cancer Network for funding the original 15–24 year AYA analysis upon which this study is based. All incidence calculations were completed by Ma Yi (biostatistician, Canterbury District Health Board). Survival analyses were conducted by Jonathan Williman (biostatistician, University of Otago), utilising Stata® syntax written for the 15–24 year AYA analysis by Vladimir Stevanovic (Principal Technical Specialist, Ministry of Health). We acknowledge the support of the Ministry of Health Analytics team in providing the registry data for this study and Susan Hanna at the New Zealand Cancer Registry for her collaboration to resolve a small number of data anomalies identified during the initial stages of the study. 

Correspondence

Mrs Kirsten R Ballantine, National Child Cancer Network, Riccarton Road, Christchurch 8140.

Correspondence Email

kirsten.ballantine@cdhb.health.nz

Competing Interests

Dr Utley reports grants from The University of Otago during the conduct of the study.

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