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A New Field of Medicine: Adolescent and Young Adult Medicine

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Movember (formerly November) is a month of reflection and recognizing the importance of men's health issues. Of the more than 8,000 diagnosed with testicular cancer every year in the United States, the peak age group is the 20-39 year olds.

How can a 24-year-old male have testicular cancer?

Traditionally medicine has been divided into pediatrics, adult and geriatric medicine. Today the way we provide age-appropriate care is shifting with the rise of a new field of medicine focusing specifically on adolescents and young adults, age 15-39, beginning with cancer treatment.

According to the National Cancer Institute, over the past 20 years while overall survival rates for cancer have increased for all age groups, the 15-39 age group has experienced little improvement in cancer survival rates seen by older and younger peers. Variables affecting this survival plateau range from limits in access to care/clinical trials, different biology, unique psychosocial issues as well as the overall mentality of thinking one is too young to have cancer.

Recently, the Colorado Medical Society placed itself at the forefront of changing the way medicine provides care by passing Res-7A-AM11, which recognizes the importance of adolescent and young adults (AYA) with cancer, and importantly focusing on the newly-created International Charter of Rights for Young People with Cancer. Res-7A-AM11 is the first resolution supported by a collective group of physicians from diverse specialties all recognizing that any young patient of theirs -- whether seeing a family doctor or pulmonologist -- is at risk for cancer. Additionally, the charter recognizes the converse; that any one of their young patients may be a survivor of cancer, which can have lasting impacts on fertility, increased risk for secondary cancers or physical/mental changes. All of these concerns can and should affect the approach a physician uses to treat their young patient.

To sum up the AYA concerns expressed in the international charter, medicine needs to provide age-appropriate care and continued care. This isn't a new concept, just one that appropriately responds to age-defined needs. Leaders such as Dr. Leonard Sender, director of the combined Adolescent & Young Adult Cancer Program University of California, Irvine and CHOC Children's Hospital, have taken the first steps in establishing the peer-reviewed Journal of Adolescent and Young Adult Oncology and complementary professional society.

In order to increase survivorship for a generation that has fallen through the gaps in medical practice, the medical community needs stronger scientific research, improvements in the way psychosocial issues are addressed and self-empowerment. The medical community needs to increase understanding of the adolescent and young adult age group and their unique risk factors for cancer. Along with continued education, clinical and epidemiological research must improve in order for the medical community to understand what makes this age group so unique.

On the patient side, the AYA community generally believes they are invincible and will not succumb to the diseases that affect "little kids and older people." This is a myth we must unfortunately dispel. Encouraging this age group to create a sense of ownership and self advocacy can be difficult. The majority of AYAs are using social media and different forms of communication. As traditional modes of communications no longer are ideal platforms for outreach to young people, so too are traditional methods of how medical care is delivered inside and outside of the clinic. The future of empowering young people to understand their body best can come through emerging technologies that focus on improved communication between a physician and their young patients.

A health care provider's responsibilities go beyond the clinic; they must be partners in developing age-appropriate programs in order to ensure the survival of cancer patients -- particularly pediatrics and adolescents through to young adults. Just as important, there needs to be a sense of ownership from adolescent and young adult cancer patients, so that their voice is not blurred by misdiagnosis or delayed treatment. Ownership begins with patients taking control of their health and starting with the simple questions to their physicians, "Did you know there is an adolescent and young adult cancer segment called AYA?"

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