In sickness and in health: transition of cancer-related care for older adolescents and young adults.
With nearly 80% of childhood cancer patients achieving cure, there are more adult survivors living now than at any other time in history. Because they are at risk for developing complications of treatment years later, it is recommended that survivors undergo systematic, regular monitoring into young adulthood and beyond. Occasionally, older adolescents and young adults are diagnosed with a relapsed, secondary or primary malignancy that requires urgent care. How best to manage each of these situations is a major challenge. A review of literature and clinical experience was performed. The medical, developmental, and psychosocial characteristics of older adolescents and young adults argue for a planned transition of care from a pediatric to more appropriate adult setting at that age. The 'health-oriented transition' involves the relatively healthy survivor, where an adult-oriented provider must be identified and supplied with a comprehensive treatment history, problem list, and monitoring plan. Continuity of medical insurance coverage must be preserved. The 2 basic models for this type of transition are either institution- or community-based. Each has relative advantages and disadvantages. In both, education and empowerment of the survivor are fundamental. The 'crisis-oriented transition' involves the older adolescent or young adult who is diagnosed in the pediatric setting with relapsed, secondary or primary cancer and is rapidly moved into the adult setting to begin treatment. With minimal time for preparation, this transition requires collaborative efforts by the pediatric and adult oncology teams. Having the capability to address both types of transition should be a central goal of any pediatric and adolescent oncology program.
Freyer
David R
DR
After-Care and Transition (ACT) Program, Division of Pediatric Hematology/Oncology and Blood and Bone Marrow Transplantation, DeVos Children's Hospital, Grand Rapids, Michigan 49503, USA. david.freyer@spectrum-health.org
Kibrick-Lazear
Rhonda
R
D000293:Adolescent; D000328:Adult; D003266:Continuity of Patient Care; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010360:Patient Transfer; D010372:Pediatrics; D017741:Survivors