Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service.

AIMS: Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results. MATERIALS AND METHODS: We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results. RESULTS: Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services. CONCLUSIONS: YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.

Phialophora corneal ulcer.

BACKGROUND: A corneal fungal ulcer which appeared to be quite superficial clinically, was found by histologic examination to unexpectedly involve the full thickness of the cornea. METHODS: A patient with an apparent superficial corneal fungal ulcer due to Phialophora species was resistant to topical and intravenous antifungal therapy. RESULTS: Penetrating keratoplasty cured the condition with retention of normal vision with a follow-up of two years. CONCLUSIONS: If keratomycosis is unresponsive to topical and intravenous antifungal therapy, penetrating keratoplasty may be required to eliminate the infection. Resistance to medical therapy might suggest presence of fungus far deeper in the cornea than suspected clinically.

Atypical mycobacterium keratitis.

We present two cases of Mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.

Non-traumatic mycotic keratitis.

Two patients presented with culture proven Paecilomyces corneal infection, and a further patient with histologic evidence of fungal infection, on deep corneal biopsy. In all three cases the corneal infection was macroscopically present only in the depth of the cornea and on the endothelial surface with an intact epithelium and no overlying stromal involvement. Repeated surgery with large corneo-scleral grafts in two cases, and with medical therapy and a small patch-graft alone in the third case, resulted in long-term eradication of the infection and preservation of the globes. Antecedent modulation with steroid and/or cyclophosphamide may well have delayed the diagnosis, however, as there was no history of trauma in any of these cases, we postulate that these infections were not exogenously derived.

Steroid sensitive Acanthamoeba keratitis.

A 44-year-old woman with proven Acanthamoeba keratitis was successfully treated medically with resultant 6/9 vision. During the treatment, repeated attempts to titrate the patient off topical corticosteroids resulted in recurrent flare-up of inflammatory keratitis from which Acanthamoeba could not be recultured. It is suggested that steroid administration during the course of Acanthamoeba keratitis may need to be withdrawn extremely slowly to avoid the recurrence of what appears to be an immunological corneal reaction.

Intralenticular infections.

Antecedent trauma resulting in endophthalmitis is not uncommon. However, primary intralenticular infection is a rare occurrence. Primary intralenticular fungal infection has not been previously reported. The authors present two cases: one of Paecilomyces infection and the other of Staphylococcus epidermidis infection limited to the crystalline lens. Both cases illustrate a delay in diagnosis.