Abstract
I
Central nervous system tumors have unique long-term consequences for survivors of pediatric, adolescent, and young adult cancer. The issues of neurocognitive functioning and its association to health-related quality of life in young adult survivors is understudied. In their Original article, Hocking et al. explore the role family functioning plays in mediating the association between neurocognitive functioning and health-related quality of life in young adult survivors of brain tumors, potential associations that have clinical relevance and therefore need to be considered when evaluating neurocognitive effects in survivors.
Next in JAYAO is an Original article by Valle and colleagues that explores the very AYA-relevant topic of social media by looking at mediators of physical activity in young adult cancer survivors utilizing the Facebook social media application. The use of social media by the AYA demographic suggests that interventions that utilize social media as tools will become more popular and it is important to ensure that academic rigor be applied to its use in clinical and research applications.
JAYAO represents all diseases that are found in the AYA-aged cancer patient and survivor population, and by the numbers, breast cancer is one of the most common tumor types seen in the AYA group. Breast cancer is a rare malignancy before the age of 20, and therefore is very rarely seen by pediatrician oncologists; however, in 15–39-year-old women, breast cancer is the most frequently diagnosed malignancy, 1 accounting for 14% of adolescent and young adult cancer cases 1 and 6.6% of all cases of breast cancer 2 in the United States. There are thought to be distinct biological differences that may account for the poorer outcome in pre-menopausal young adults compared that seen in the post-menopausal age group. The Young Survival Coalition (YSC), a leading advocacy group for young women with breast cancer in the United States, addressed research priorities for breast cancer in young woman, and we at JAYAO felt that it was important to bring this to our readers in a Special Article in this issue by Korde et al.: “Young Breast Cancer in Young Women: Research Priorities. A Report of the Young Survival Coalition Research Think Tank Meeting.” The research issues described in the article are relevant for many constituents, including the practicing young adult oncologist, young adult breast cancer surgeon, and pediatric oncologists.
The adolescent and young adult breast cancer patient can generally be divided into three common types of presentation. First is the patient with no known family history or no known risk factors who may develop de novo breast cancer. It is important to obtain tumor tissue for biobanking from these patients to allow more detailed genomic studies to be utilized in the era of next generation sequencing to be able to understand in greater detail the genomic landscape of these de novo breast cancers in this group of young patients. The second group that is important to practicing pediatric and adolescent/young adult oncologists are the adult survivors of pediatric cancer who may have received alkylating agents and mediastinum or chest radiation therapy, as they are now known to have increased risks of developing treatment-related malignancies such as breast cancers. For example, patients with a prior diagnosis of Hodgkin lymphoma who received radiation have a markedly increased risk of developing breast cancer 3 and therefore need to be identified and educated about the need for early detection and screening starting as young as age 25. The Children's Oncology Group's “Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers” is an excellent resource (available at www.survivorshipguidelines.org). The third group is those patients who may have a known familial predisposition to one of the genes associated with an increased predisposition to breast cancer, including the BRCA1 and BRCA2 genes; up to 15% of patients with breast cancer may have a first-degree female relative who also had breast cancer. 4 There are newer non-BRCA mutations that are being identified, including: TP53, PTEN, STK11, CHEK2, ATM, BRIP1, and PALB2. Sadly, there is still much to learn about all aspects of why pre-menopausal young women develop breast cancer, and the research priorities of the YSC are relevant to the field.
Karen Fasciano and colleagues present information on an innovative website for meeting the emotional and supportive needs of young adults with cancer in the United States in their Brief Report paper. The use of the internet and medical websites can be a useful and scientifically measurable adjunct to deliver emotional and supportive care to adolescent and young adult cancer patients.
JAYAO publishes select case reports, with particular interest in ones that reflect usual or surprising insights with relevance to AYAO. The final article in this issue is a Case Study by Houghtelin et al. describing an extra-medullary breast site of relapse of acute lymphoblastic leukemia in a patient who underwent stem cell transplantation. It is important to realize that breast disease is not always breast cancer.