Cancer adolescent pathway in France between 1988 and 1997.

We report an adolescent cancer pathway from referral, through diagnosis and treatment, to follow-up in France. All cases of cancer among 15-19 years, diagnosed from 1988 to 1997, recorded by nine French population-based cancer registries (10% of French population) were included. The management of adolescent cancer by paediatricians was rare. An adolescents' pathway through cancer care can be summarized as first visit to general practitioner, referral to adult oncologist for haematological malignancy and medical or surgical specialists for solid tumours, treatment in adult unit, and follow-up by adult oncologist, adult medical or surgical specialist, or general practitioner. Only 9% of the 15-19 years are entered into a clinical trial (respectively 6% and 3% into adult and paediatric clinical trial). The inclusion rate changes according to the diagnosis, higher for acute lymphoblastic leukaemia (39%), non-Hodgkin's lymphomas (NHL) (27%), and acute non-lymphoblastic leukaemia (20%). Only 4% of adolescent cancers were managed on shared adult/paediatric departments, especially for soft-tissue sarcomas (14.9%), malignant bone tumours (13.4), central nervous system tumours (6.2%), and NHL (4.4%). Whatever the reasons for lack of participation in clinical trials, an ideal model requiring communication and cooperation between all adult and paediatric specialists involved in adolescent cancer treatment should reduce the large gap in access to cooperative groups.

[Cancer incidence and survival among adolescents and young adults in France (1978-1997)]. / Incidence et survie des cancers de l'adolescent et de l'adulte jeune en France (1978-1997).

Malignancies are rare young French adults but represent the third significant cause of death in the cohort of 15-24 years of age. The aim of this study was to investigate incidence and survival rates of French adolescents and young adults with cancer. All cases of cancer occuring over a 20-year period (1978-1997) in the cohort of patients aged 15 to 24, were obtained from nine population-based registries (10 % of the French population). Basal cell carcinomas of the skin were excluded. 1161 and 1884 cases were recorded in adolescents and young adults, respectively. Overall incidence rates (IR) were 161.4/10(6) in adolescents aged 15-19 years (M/F ratio = 1.3), and 252.6/10(6) in young adults aged 20-24 years (M/F ratio : 1.2). During the 1978-97 period, the IRs appeared stable over the years, +0.4 % [CI95 % = -2.3 ; +3.1] (p = 0.79) for adolescents and +1.7 % [CI95 % = -4.0 ; +7.3] (p = 0.57) for young adults. Five-year overall survival rates were 69.1 % [CI95 % = 66.4-71.8] for adolescents and 74.5 % [CI95 % = 72.3-76.7] for young adults. The 5-year survival rate for patients 15-24 years improved from 62.0 % (CI95 % = 57.5-66.5) in 1978-82 to 80.2 % (IC95 % = 77.7-82.8) in 1993-97. Noteworthy, results in adolescents and young adults are poor compared to the ones from their younger counterparts, especially in patients with acute lymphoblastic leukemia, non-Hodgkin lymphoma, Ewing's sarcoma, osteosarcoma, rhabdomyosarcoma, and astrocytoma. Further studies are warranted to elucidate whether these differences are due to intrinsic biological properties of the tumor or to differences in clinical practices in the two populations.