Late RES-7A AM11
NOTE: Per the bylaws, on September 1 the Credentials Committee will determine if this resolution will be considered as late business of the 2011 CMS House of Delegates or whether it will be postponed and considered at the 2012 Annual Meeting.
Colorado Medical Society
Introduced by: Ali Ansary, Tyler Anstett, Rocky Vista University School of Osteopathic Medicine
Subject: Adolescent and Young Adult (AYA) Cancer in Medical Education
Referred to: Reference Committee on Resolutions and Reports
WHEREAS, cancer is the leading disease-related cause of death in young adults in the United States1 and affects eight times as many individuals between the ages of 15 and 40 as those younger than 15 years of age; and
WHEREAS, the 2011 International Charter of Rights for Young People with Cancer2 advocates for patients to:
1. Receive education about cancer and its prevention including early detection
2. Be taken seriously when seeking medical attention and receive the earliest possible diagnosis and speedy referral for suspected cancer
3. Have access to suitably qualified multi-disciplinary medical specialists with significant experience in treating cancer in this age group
4. Information about and reasonable access to clinical trials and treatment that has been clinically trialed with people in their age group
5. Receive age-appropriate support including, but not limited to, psychosocial, community and palliative support services
6. Empowerment in making decisions supported by full and detailed explanation of all treatment options and long-term effects of the disease enabling them to actively influence their care
7. Fertility preservation, as well as information and counseling concerning short-term and long-term effects of cancer and treatment which affect fertility
8. Have access to specialized treatment and services in age-appropriate facilities alongside their peers
9. Financial and practical support to minimize the burden of the disease during treatment
10. Elimination of all forms of discrimination, during and beyond treatment, in education, vocation and insurance, or in the community; and
WHEREAS, the International Charter of Rights for Young People with Cancer is a grassroots collaboration between major international cancer organizations which includes the United States’ Lance Armstrong Foundation and SeventyK, the United Kingdom’s Teenage Cancer Trust, Australia’s CanTeen and New Zealand’s CanTeen; and
WHEREAS, adolescent and Young Adults (AYA), ages 15-39, have 5-year survival rates less than those of both younger pediatric patients and older adults for a wide variety of tumors3,4,5; and
WHEREAS, research has begun to show an influence of developmental changes on drug absorption, distribution, metabolism and elimination; which can all be variables for how the pharmacology of anticancer agents may influence outcomes of this patient population3; and
WHEREAS, young adults have the highest percentage of uninsured – 63% under the age of 346- or underinsured individuals of any age group thus causing a significant impediment to AYAs developing a primary care relationship, obtaining appropriate referrals and second opinions, and receiving the best possible care; specifically, in 2004, 13.7 million young adults aged 19 to 29 lacked coverage, an increase of 2.5 million since 20007; and
WHEREAS, fertility is a primary concern to many adolescent and young adult cancer survivors, yet most young adult cancer survivors do not recall an adequate discussion with their physician at the initiation of therapy of the risks of infertility or methods to decrease the risks4,8; and
WHEREAS, self-image, a critical variable in growth during this phase of life, is comprised by many of the adverse effects of therapy, such as alopecia, weight gain or loss, susceptibility to infection and need for isolation, impaired sexuality and mutilating surgery4; and
WHEREAS, psychological and social factors in adolescents and young adults may put patients in this age range at a higher risk for delay in diagnosis, which in turn may impact cancer survival; the number of days from symptom onset to diagnosis increases with patient age, as much as double the number of days for older adolescents compared with patients 14 and under4; and
WHEREAS, cancer within this age group creates a prolonged mismatch between biologic maturity and psychosocial maturity and creates conflict when young people become seriously ill as they are separating from parents; relationships among parents and friends are changing, health and personal finances are unreliable, and emotional and psychological adjustments are complicated by the massive changes occurring within normal development3,; and
WHEREAS, cancer patients between age 15 to 35 years have had the lowest proportion of patients accrued to clinical trials with only 10% entered into a clinical trial compared to the 90% of children younger than age 15 years4; and
WHEREAS, current limited research suggests that the primary barriers to communication include physician knowledge and attitudes about fertility preservation, physician skill related to discussing psychosocial issues about cancer survivorship and financial constraints6; and
WHEREAS, the National Cancer Institute and the Lance Armstrong Foundation jointly sponsored the Adolescent and Young Adult Oncology Progress Review Group (AYAO PRG) that recommend “to provide education, training, and communication to improve awareness, prevention, access, and quality of care for AYAs”7; and
WHEREAS, The CMS is one of the single most influential association of physicians and medical students with a mission to promote the art and science of medicine and the betterment of public health; and
WHEREAS, as the largest association of physicians and medical students in the state of Colorado, the CMS has a unique ability to emphasize the importance of comprehensive quality care; and
WHEREAS, the AAMC, AACOM and AOA are committed to educating future physicians about disease epidemiology and health care disparities; and
WHEREAS, the stated purpose of the ACGME is to promote the quality of graduate medical education, which includes teaching resident physicians about important health issues affecting Americans; therefore be it
RESOLVED, that the CMS recognize the importance of Adolescent and Young Adult Cancers; and be it further
RESOLVED, that the CMS study promoting and endorsing the International Charter of Rights for Young People with Cancer or parallel or similar CMS developed language and encouraging all member societies of the CMS House of Delegates to consider promoting and endorsing the International Charter of Rights for Young People with Cancer or parallel or similar CMS developed language; and be it further
RESOLVED, that the CMS support the work of AAMC, AACOM, ACGME, AOA, and other relevant organizations in developing core competencies to ensure that medical students and residents are familiar with the unique medical, social and psychological issues posed by AYA cancer.
References:
1. Bleyer A, Barr R: Highlights and challenges, in Bleyer A, O’Leary M, Barr R, et al (eds): Cancer Epidemiology in Older Adolescents and Young Adults 15 to 29 Years of Age, Including SEER Incidence and Survival: 1975-2000. Bethesda, MD National Cancer Institute, NIH publication 06-5767, 2006
2. International Charter of Rights for Young People with Cancer. Available at http://www.cancercharter.org. Accessed March 7, 2011.
3. Veal, GJ, Hartford, CM, and Stewart, CF. Clinical Pharmacology in Adoelscent Oncology Patient. J Clin Oncol 28:4790-4799
4. Bleyer A. Young Adult Oncology: The Patients and Their Survival Challenges. CA Cancer J Clin. 2007; 57: 242-255.
5. Bleyer A, Barr R, Hayes-Lattin B, et al: The distinctive biology of cancer in adolescents and young adults. Nat Rev Cancer 8:288-298, 2008
6. US Department of Health & Human Services. Overview of the Uninsured in the United States Population. An Analysis of the 2005 Current Population Survey. September 2005. http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm#age
7. Adolescent and Young Adult Oncology Progress Review Group. Closing the Gap: Research and Care Imperatives for Adolescents and Young Adults with Cancer. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, and the LiveStrong Young Adult Alliance.
8. Levine J, Canada A, and Stern CJ. Fertility Preservation in Adolescents and Young Adults With Cancer. J Clin Oncol 28:4831-4841.
Road Map – Patient Safety and Professional Accountability
Relevant CMS Policy – None
Relevant AMA and MSS Policy:
H-55.976 Skin Cancer Prevention Education in Communities of Color
(1) supports and encourages prevention efforts to increase awareness of skin cancer risks and sun-protective behavior in communities of color; and (2) will work with the American Academy of Dermatology, National Medical Association and National Hispanic Medical Association and public health organizations to promote education on the importance of skin cancer screening and skin cancer screening in patients of color. (Res. 510, A-10)
FISCAL IMPACT: None