Research in context
Evidence before this study
Long-term outcomes in survivors of cancer diagnosed during adolescence or young adulthood are not well understood. We searched PubMed from database inception to May 18, 2019, using the terms “adolescent and young adult or AYA cancer survivors” and “health conditions or morbidity” and “death or mortality” for English language publications describing the health consequences of cancer treatment in this population. Many studies have described the important psychosocial consequences of being treated for cancer as an adolescent or young adult, including decrements in health-related quality of life. Several studies have examined the morbidity and mortality of adolescents and young adults based on large cancer registries (eg, registries in Denmark and in England and Wales); however, detailed treatment exposure data or severity of illness were not considered in these studies.
Added value of the study
To our knowledge, this retrospective cohort study is the first to provide a comprehensive assessment of long-term health outcomes in early-adolescent and young adult cancer survivors. We used detailed outcome and treatment data to summarise the long-term outcomes of early-adolescent and young adult survivors in comparison with survivors of childhood cancer (aged <15 years at diagnosis), a cohort of siblings, and the general population. In general, the patterns of chronic health conditions in early-adolescent and young adult survivors reflect those of childhood cancer survivors, although we identified differences in risk for non-recurrent, health-related causes of death and chronic cardiac, endocrine, and musculoskeletal conditions between survivors of childhood cancer and early-adolescent and young adult cancer (despite similar treatment exposures).
Implications of all the available evidence
Our previous understanding of the long-term consequences of cancer treatment on adolescents and young adults was largely extrapolated from data describing survivors of childhood cancer. This analysis confirms the substantial burden of long-term health complications in the youngest subset of adolescents and young adults, can be used to inform current therapies for this population, and underscores the need for targeted interventions to ensure life-long, risk-based follow-up care for this population.