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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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.



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.


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.


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.


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.


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. 


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

Correspondence Email


Competing Interests

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


  1. Bleyer WA, O’Leary M, Barr R, Ries LAG (Eds). Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975–2000. National Cancer Institute: Bethesda MD; June, 2006.
  2. Michelagnoli MP, Pritchard J, Phillips MB. Adolescent oncology—a homeland for the “lost tribe.” Eur J Cancer. 2003;39:2571–2. 
  3. Bleyer A. Young adult oncology: the patients and their survival challenges. CA Cancer J Clin. 2007; 57:242–255.
  4. Ferrari A, Bleyer A. Participation of adolescents with cancer in clinical trials. Cancer Treat Rev. 2007; 33:603–8.
  5. Ferrari A, Thomas D, Frankin ARK, et al. Starting an adolescent and young adult program: some success stories and some obstacles to overcome. J Clin Oncol. 2010; 28:4850–7.
  6. Ministry of Health. Coordination of the adolescent/young adult cancer service: service specification tier level three. Wellington: Ministry of Health: November; 2009. Accessed December 8, 2015 from: http://nsfl.health.govt.nz/system/files/documents/specifications/coordinationoftheayacancerservicespecificationfinaldec09.doc
  7. What should the age range be for AYA oncology? J Adolesc Young Adult Oncol. 2011; 1(1):3–10.
  8. Gatta G, Zigon G, Capocaccia R, et al. Survival of European children and young adults with cancer diagnosed 1995–2002. Eur J Cancer. 2009; 45(6):992–1005.
  9. Alston RD, Geraci M, Eden TOB, et al. Changes in cancer incidence in teenagers and young adults (ages 13–24 years) in England 1979–2003. Cancer. 2008; 113(10):2807–15.
  10. Cancer Australia in collaboration with CanTeen. National Service Delivery Framework for Adolescents and Young Adults with Cancer. Canberra, Australia: Australian Government, Cancer Australia, 2008. Accessed December 8, 2015 from: http://canceraustralia.gov.au/sites/default/files/publications/national_servicce_delivery_framework_for_adolescents_and_young_adults_with_cancer_teen_52f301c25de9b.pdf
  11. Grieger AM, Castellino SM. Delineating the age ranges used to define adolescents and young adults. J Clin Oncol. 2011; 29(16):e492–3.
  12. Barr RD, Ferrari A, Ries L, et al. Cancer in adolescents and young adults: a narrative review of the current status and a view of the future. JAMA Pediatrics. 2016; 170(5):495–501.
  13. Ministry of Health. Youth health: a guide to action. Wellington: Ministry of Health: September; 2002. Accessed December 19, 2016 from: http://www.health.govt.nz/publication/youth-health-guide-action 
  14. Ministry of Youth Affairs. Youth development strategy Aotearoa. Wellington: Ministry of Youth Affairs: January; 2002. Accessed December 19, 2016 from:
  15. Ballantine KR, Watson H, Macfarlane S, et al. Small numbers, big challenges: adolescent and young adult cancer incidence and survival in New Zealand. J Adolesc Young Adult Oncol. 2017; 6(2):277–85.
  16. Ballantine K, Sullivan M. Adolescent and young adult cancer incidence and survival in New Zealand 2000-2009. Auckland: National Child Cancer Network; 2013. Accessed June 1, 2017 from: http://ayacancernetwork.org.nz/research-and-evaluation 
  17. Barr RD, Holowaty EJ, Birch JM. Classification schemes for tumors diagnosed in adolescents and young adults. Cancer. 2006; 106:1425–30.
  18. National Cancer Institute Surveillance, Epidemiology and End Results Program. AYA site recode. 2012. Accessed December 8, 2015 from: http://seer.cancer.gov/ayacode/aya-who2008.html
  19. Sullivan M, Ballantine K. The incidence of childhood cancer incidence in New Zealand 2000–2009. Auckland: National Child Cancer Network; 2014. Accessed April 15, 2016 from: http://childcancernetwork.cp-design.co.nz/wp-content/uploads/2015/10/Childhood-Cancer-Survival-in-New-Zealand-2000-2009-1.pdf
  20. Howlader N, Noone AM, Krapcho M, et al. (Eds). SEER Cancer Statistics Review, 1975–2009, National Cancer Institute. Bethesda, MD; based on November 2011 SEER data submission, posted to the SEER web site, April 2012. http://seer.cancer.gov/csr/1975_2009_pops09/ 
  21. De P, Ellison LF, Barr RD, et al. Canadian adolescents and young adults with cancer: opportunity to improve coordination and level of care. CMAJ. 2011; 183(3):e187–94.
  22. Sneyd MJ, Cox B. A comparison of trends in mortality in New Zealand and Australia: the two countries with the highest melanoma incidence and mortality in the world. BMC Cancer. 2013; 13:272.
  23. Australian Institute of Health and Welfare. Cancer in adolescents and young adults in Australia. Cancer series no. 62. Cat. No. CAN 59. Canberra: AIHW. Accessed April 15, 2016 from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737420600
  24. Gondos A, Hiripi E, Holleczek B, et al. Survival among adolescents and young adults with cancer in Germany and the United States: an international comparison. Int. J. Cancer. 2013; 133(9):2207–15.
  25. Curtis E, Wright C, Wall M. The epidemiology of breast cancer in Māori women in Aotearoa New Zealand: implications for screening and treatment. N Z Med J. 2005; 118(1209):1–10.
  26. DeRouen MC, Gomez SL, Press DJ, et al. A population-based observational study of first-course treatment and survival for adolescent and young adult females with breast cancer. J Adolesc Young Adult Oncol. 2013; 2(3):95–103.
  27. Carey LA, Perou CM, Livasy Ca, et al. Race, breast cancer subtypes, and survival in the Carolina Brast Cancer Study. J Am Med Assoc. 2006; 295(21):2492–502. 
  28. Pettit T, Watson H. Service Provision for Adolescent and Young Adult Cancer Patients in New Zealand including Standards of Care. Auckland. AYA Cancer Network Aotearoa; 2016. Accessed May 12 2017 from: http://ayacancernetwork.org.nz/assets/frontend/AYAStandards_of_care_final.pdf 
  29. Bleyer A. The quid pro quo of pediatric versus adult services for older adolescent cancer patients. Pediatr Blood Cancer. 2010; 54:238–41.
  30. Bleyer A, Siegel SE, Coccia PF, et al. Children, adolescents, and young adults with leukemia: the empty half of the glass is growing. J Clin Oncol. 2012; 30(10):4037–8.
  31. Sullivan M, Ballantine K. Child cancer survival in New Zealand 2000–2009: the first outcome analysis of the New Zealand Children’s Cancer Registry. Auckland: National Child Cancer Network; 2014. Accessed April 15, 2016 from: http://childcancernetwork.cp-design.co.nz/wp-content/uploads/2015/10/Childhood-Cancer-Incidence-in-New-Zealand-2000-2009-1.pdf 


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