Cooperative Group and cancer center Limitations

Pediatric and adult cooperative groups and cancer centers may not allow the enrollment of adolescent and young adults onto clinical trials because of restrictive eligibility criteria. A clinical trial may not be available. Adult cooperative groups and cancer centers may lack treatment protocols for younger patients. Pediatric cooperative groups and hospitals may lack treatment protocols for older patients. Clinical trials for the types of cancer that predominate among adolescents and young adults may not be a priority of the cooperative group enterprise.

Adding to this problem is the fact that there is no discipline in medicine devoted to this group. Neither pediatric oncologists nor oncologists who care for adult patients are trained - certainly not optimally -for this set of diseases. Moreover, even those diseases that appear to be the same often have biologic differences. For example, adolescents have different forms of leukemia than either younger or older persons. In particular, the biologic characteristics (and prognosis) of ALL change dramatically in postpubertal patients. Different biologies, likely to respond differently to therapeutics, might best be studied in dedicated and separate clinical trials.

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