title: Cancer adolescent pathway in France between 1988 and 1997.
abstract: We report an adolescent cancer pathway from referral, through diagnosis and treatment, to follow-up in France. All cases of cancer among 15-19 years, diagnosed from 1988 to 1997, recorded by nine French population-based cancer registries (10% of French population) were included. The management of adolescent cancer by paediatricians was rare. An adolescents' pathway through cancer care can be summarized as first visit to general practitioner, referral to adult oncologist for haematological malignancy and medical or surgical specialists for solid tumours, treatment in adult unit, and follow-up by adult oncologist, adult medical or surgical specialist, or general practitioner. Only 9% of the 15-19 years are entered into a clinical trial (respectively 6% and 3% into adult and paediatric clinical trial). The inclusion rate changes according to the diagnosis, higher for acute lymphoblastic leukaemia (39%), non-Hodgkin's lymphomas (NHL) (27%), and acute non-lymphoblastic leukaemia (20%). Only 4% of adolescent cancers were managed on shared adult/paediatric departments, especially for soft-tissue sarcomas (14.9%), malignant bone tumours (13.4), central nervous system tumours (6.2%), and NHL (4.4%). Whatever the reasons for lack of participation in clinical trials, an ideal model requiring communication and cooperation between all adult and paediatric specialists involved in adolescent cancer treatment should reduce the large gap in access to cooperative groups.
authors.affiliation: French National Registry of Childhood Solid Tumours, Vandoeuvre-lès-Nancy, France. e.desandes@chu-nancy.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Desandes
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lacour
authors.forename: Danièle
authors.initials: D
authors.lastname: Sommelet
authors.forename: Mélanie
authors.initials: M
authors.lastname: White-Koning
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.forename: Brigitte
authors.initials: B
authors.lastname: Tretarre
authors.forename: Angelina
authors.initials: A
authors.lastname: Marr
authors.forename: Nabil
authors.initials: N
authors.lastname: Maarouf
authors.forename: Anne-Valérie
authors.initials: AV
authors.lastname: Guizard
authors.forename: Patricia
authors.initials: P
authors.lastname: Delafosse
authors.forename: Arlette
authors.initials: A
authors.lastname: Danzon
authors.forename: Christine
authors.initials: C
authors.lastname: Cotte
authors.forename: Laurence
authors.initials: L
authors.lastname: Brugieres
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000458:organization & administration*; D002986:Clinical Trials as Topic; D003142:Communication; D018672:Community Health Planning; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration*; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D013043:Specialties, Surgical / Q000458:organization & administration; D015996:Survival Rate