Quality of Survival

The quality of survival, both during and after therapy, is a critical issue for adolescents and young adults. Quality of life is poor during the months and years when most adolescents and young adults with cancer are treated, and the acute and delayed toxicities of cancer therapy are undeniably among the worst associated with the treatment of any chronic disease. The acute toxicities of nausea, vomiting, mucositis, alopecia, weight gain (or excessive loss), acne, bleeding, and infection are generally harder for adolescents to cope with than for either younger or older persons. Delayed complications may be of low concern to patients in this age group during treatment, but after therapy has been completed these complications can be frightening and real. Cardiomyopathies, growth disturbances, and neu-ropsychological side effects are examples of adverse late effects that are hard to describe in a meaningful way before initiating therapy to an adolescent or young adult. A particularly tragic example of an unanticipated late effect is the development of a second malignancy in a patient cured of their original disease.

Many adolescent and young adult cancer survivors cite fertility as a primary concern that impacts the quality of their life. Most do not recall an adequate discussion of the risks of infertility or methods to decrease the risks with their physician at the initiation of therapy. The risk of infertility for an individual is difficult to predict. Direct radiation exposure of the gonad had been studied more extensively than other chemotherapy exposures. Permanent ovarian damage occurs between 5 and 20 Gy, with higher doses required in younger females [68]. The male germinal epithelium is much more sensitive to radiation-induced damage, with changes to spermatogonia resulting from as little as 0.2 Gy. Testicular doses of less than 0.2 Gy had no significant effect on follicle-stimulating hormone

(FSH) levels or sperm counts, whereas doses between 0.2 and 0.7 Gy caused a transient dose-dependent increase in FSH and a reduction in sperm concentration, with a return to normal values within 12 to 24 months. No radiation dose threshold has been defined above which permanent azoospermia is inevitable; however, doses of 1.2 Gy and above are likely to be associated with a reduced risk of recovery of sper-matogenesis. The time to recovery, if it is to occur, is also likely to be dose dependent [69]. Cranial radiation impairs gonadal hormone synthesis and can result in a decreased production of luteinizing and follicle-stimulating hormones. Alkylating chemotherapeutic agents carry a high risk of infertility, but the exact dose required or the rates associated with combination agents are unavailable. Recommendations for preservation, evaluation, and counseling have recently become available [70-73].

The quality-of-life issues that arise during and after cancer therapy have been the focus of studies in children and older adults, but have not received the same attention or study in adolescents and young adults. A few studies have found certain trends that should be tested in future studies. A higher risk-taking behavior has been noted among survivors of Hodgkin lymphoma occurring during childhood and adolescence [74], an observation that does not appear to be limited to this disease. On the other hand, evidence also suggests that adolescent and young adult cancer survivors show better attendance and performance at school and work [75]. Persistent anxiety over relapse, death, or late effects is likely to be higher in adolescents who were cognitively aware of the severity of their illness than in those treated in early childhood (the Damocles syndrome) [76]. The paucity of quality-of-life data in this age group is another manifestation of the general neglect of these patients.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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