Domain
Examples
Medical
Oncology, palliation, nutrition, endocrinology, etc.
Emotional
Psychology, coping, distress
Physical
Exercise, activities of daily living, myopathy
Neurocognitive
Education, vocation
Social
Relationships with peers and providers
Reproductive
Fertility preservation, parenting options
Financial
Disability, insurance
Lifestyle issues
Environment, risky behaviors, balance with treatment
Late effects
Prevention, monitoring
Care community
Caregivers, family, friends
Priority concerns for these domains are listed below:
9.1 Medical
1.
Leukemias, lymphomas, and germ cell tumors are common cancers among AYA-aged patients; HSCT may play an important role in the therapy of these malignancies:
a.
Compared to children, the treatment-related morbidity and mortality may be increased for AYAs, but less so than for older adults.
b.
Changes in initial treatment (such as pediatric-inspired therapies for acute lymphoblastic leukemia) have led to a reconsideration of the role of HSCT in first remission in some circumstances.
c.
An increased understanding of unique biologic features in cancers among AYAs compared to children or older adults may alter prognostic tools and the recommended role and timing of HSCT for the AYA patient.
2.
Attention to age-specific details related to growth and development may influence medical needs and care, including issues in endocrinology (see also Chap. 26) and nutrition:
a.
Growth hormone
b.
Thyroid
c.
Gonadotropins
d.
Adrenal
3.
A variety of genetic syndromes may present with cancer in the AYA age range including Fanconi anemia, Li–Fraumeni syndrome, dyskeratosis congenita, and others.
9.2 Emotional
1.
Distress, depression, anxiety
2.
Issues of existentialism
3.
Sexuality
4.
Development of coping mechanisms
9.3 Physical
1.
Changes in appearance
2.
Sexual development and function
3.
Activity limitations
9.4 Neurocognitive
1.
Neuropsychological assessments
a.
Consider formal assessment at baseline with follow-up assessments as indicated
2.
Vocational training
9.5 Social
1.
Changes in peer relationships
2.
Family relationships (spouse, children, parents):
a.
Loss of autonomy
b.
Changes in roles and responsibilities
3.
Coworkers and employer
4.
Health-care providers, many of whom may also be young adults
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