Teenagers and Young Adults TYAs Nicola Chesman Specialist

Teenagers and Young Adults (TYAs) Nicola Chesman Specialist physiotherapist for TYAs with cancer The Christie

“Cancer at a young age comes with its own particular set of challenges. Our services put the needs of young people first and allow them to face those challenges together. ”

Planning future life Identity development Gaining autonomy from parents Developing and maturing Risk takers Struggle to see things from someone else’s point of view Instant gratification Negotiating relationships Take less responsibility for own health Foundation for lifelong habits

Living with and beyond cancer • Cardiomyopathy • Pulmonary changes • Breathlessness • Peripheral neuropathy • Pain • Musculoskeletal dysfunction • Neurological weakness • Neurocognitive changes • Fatigue • Weight changes • Psychological effects • Reduction in activity • Complications of disuse

Living with and beyond cancer • By age 50 years: Ø 99. 9% had at least one chronic health condition (96% at least one severe) ØAverage burden of 17 CHCs (5 severe, disabling or life threatening) ØOlder age at diagnosis associated with greater number and severity of CHCs • Increased risk of second malignancy • Two-fold risk of developing cardiovascular disease • More likely to: ØBe unable to work / out of work ØExperience more days of poor mental health and physical health Bhakta et al, 2017; Ahmad et al, 2016; Chao et al, 2016; Tai et al, 2012

Behaviours during and after treatment • 9 -30% of TYAs meet activity guidelines during treatment • Previous levels of activity not regained posttreatment • 40% not meeting dietary recommendations; more likely to binge drink • Insufficient / inappropriate information provided Pugh et al, 2019; Pugh et al, 2018; Murnane et al, 2015

Evidence for intervention • Positive effect on function and quality of life (Munsie et al, 2019; Grimshaw et al, 2016) • TYAs want information and to improve lifestyle behaviours (Pugh et al, 2019) • Vigorous exercise associated with lower risk of CV events (Jones et al, 2014) • “Prehab” during chemotherapy prior to lower limb surgery increased function in young sarcoma patients (Corr et al, 2017)

Current services • Referral to allied health professionals • Ethos of care of TYA unit • GM Prehab • ERAS+ • PARS • Third sector – MOVE charity, Trekstock, TCT, CLIC Sargent

Challenges • Multiple diseases • Urgency of treatment • Intensive treatment regimes • Treatment restrictions • Normal development • Providing age-specific peer support in the context of low numbers

Opportunities • JLA top 10 research priorities for TYA cancer care • Age-specific information • Age-specific exercise / lifestyle interventions • Prehab for certain groups?

Conclusion • TYAs are a unique group • Lifelong increased risk of morbidity and mortality • Non-optimal lifestyle behaviours • Not systematically addressed • Opportunity to develop policy and services to optimise health in short and long term.

References • Ahmad et al, 2016, “Anticancer chemotherapy in teenagers and young adults: Managing long term side effects”, BMJ, 354, i 4567 • Bhakta et al, 2017, “The cumulative burden of surviving childhood cancer: An initial report from the St Jude Lifetime Cohort Study (SJLIFE), Lancet, 390, 2569 -2582 • Chao et al, 2016, “Cardiovascular disease risk profiles in survivors of adolescent and young adult cancer: The Kaiser Permanente AYA cancer survivors study”, Journal of Clinical Oncology, 1626 -1633 • Corr et al, 2017, “Feasibility and functional outcomes of children and adolescents undergoing preoperative chemotherapy prior to a limb-sparing procedure or amputation”, Rehabilitation Oncology, 35 (1), 38 -45. • Jones et al, 2014, “Exercise and risk of major cardiovascular events in adult survivors of childhood Hodgkin lymphoma: a report from the childhood cancer survivor study”, Journal of Clinical Oncology, 32, 3643 -50 • Grimshaw et al, 2016, “The feasibility of physical activity interventions during the intense treatment phase for children and adolescents with cancer: A systematic review. ”, Pediatric Blood and Cancer, 63, 1586 -1593. • Munsie et al, 2019, “The benefit of physical activity in adolescent and young adult cancer patients during and after treatment: A systematic review. ”, Journal of Adolescent and Young Adult Oncology, DOI: 10. 1089/jayao. 2019. 0013 • Murnane et al, 2015, “Adolescents and young adult cancer survivors: Exercise habits, quality of life and physical activity preferences”, Supportive Care in Cancer, 23, 501 -510. • Pugh et al, 2019, “The health behaviour status of teenage and young adult cancer patients and survivors in the United Kingdom”, Supportive Care in Cancer, DOI: 10. 1007/s 00520 -019 -04719 -y • Pugh et al, 2018, “The lifestyle information and intervention preferences of teenage and young adult cancer survivors”, Cancer Nursing, 41 (5), 389 -398. • Tai et al, 2012, “Health status of adolescent and young adult cancer survivors”, Cancer, 118, 4884 -4891