Volume 180 - Issue 12
Cancer in adolescents and young adults
Authors: Anne E Mitchell, Deborah L Scarcella, Gemma L Rigutto, David M Ashley, Vicky J Thursfield, Graham G Giles and Maree Sexton
Med J Aust 2004; 180 (12): 653-654. || doi: 10.5694/j.1326-5377.2004.tb06140.x
Published online: 21 June 2004
Published online: 21 June 2004
In reply: Thomson is correct in stating that patients involved in clinical trials have better 5-year survival rates when compared with patients not recruited into clinical trials. There may, as Thomson points out, be numerous possible explanations for this finding. Nonetheless, this improvement in survival is well documented and has been recognised for some time.1
Although it is becoming increasingly important to focus on other therapeutic outcomes, such as quality of life, it is incorrect to assume that involvement in clinical cancer trials equates to impairment of quality of life and an increase in adverse effects. In fact, the primary end-point of numerous clinical cancer trials is improved quality of life.2
We agree with Thomson when he states that patients anywhere in the country should be able to access current best-practice treatment. We agree that best-practice treatment can only be defined through the conduct of clinical trials. Hence, well designed clinical trials are necessary, and indeed crucial, to the advancement of cancer therapy. In the context of adolescents and young adults with cancer, the lower than expected improvement in survival may be explained, in part, by a low rate of participation in clinical trials.3 There is no doubt that participation in late-phase clinical trials provides a “benchmark” and ensures the provision of quality medical care. Rural and regional settings should not, a priori, be a barrier to trial participation. Adequate infrastructure and support should be available for such centres to participate.
Greater cooperation between all adult and paediatric clinicians involved in the care of adolescents and young adults with cancer is essential to ensure that the inequity in survival is corrected.
References
- Stiller CA, Draper GJ. Treatment centre size, entry to clinical trials, and survival in acute lymphoblastic leukaemia. Arch Dis Child 1989; 64: 657-661. CHDIFGGH
- Bottomley A, Vanvoorden V, Flechtner H, Therasse P. The challenges and achievements involved in implementing Quality of Life research in cancer clinical trials. Eur J Cancer 2003; 39: 275-285. CHDEBFGI
- Albritton K, Bleyer WA. The management of cancer in the older adolescent. Eur J Cancer 2003; 39: 2584-2599. CHDBCFAH