The Impact of Adolescent and Young Adult Cancer-AJA-on Family Functioning.Study of Family Relationships in Terms of Adaptability and Cohesion

Objectives:The arrival of cancer in adolescents and young adults(aged 15 to 24 years)-Adolescents and young adults(AJA)-corresponds to a fragile period during which the adulthood of the young person and the evolution of family ties mobilize the family as a whole.Therefore,cancer,beyond its individual traumatic dimension,affects the whole family,which can modify family ties and family functioning.Our objective is to evaluate family functioning from the complex model evaluating cohesion and adaptability when an adolescent or young adult has cancer.Methods:Adolescents and young adults with cancer(n=41),mothers(n=41),and fathers(n=13)participated in this study.They completed the Family Adaptation and Cohesion Scales(FACES Ⅲ)questionnaire.Family functioning when an aya is ill has been compared to that of families without any disease.Results:a comparison of the mean scores of perceived cohesion and adaptability of face Ⅲ indicates no significant difference for cohesion.In contrast,the averages of the adaptability scores of our sample with those of the general population indicate that families with cancer hais generally feel more“adaptable”than the non-clinical population.These results are statistically significant for AJA,but also for mothers and fathers.Regarding the mean scores of ideal cohesion and ideal adaptability,there are no significant differences between fathers in our sample and fathers in the general population.In contrast,mothers in our sample had less ideal adaptability than those in the general population.In aya patients with cancer,the scores of both adaptability and cohesion were significantly different from those of non-diseased adolescents.Conclusion:Cancer leads to many changes in family relationships,making it difficult to empower the young patient and latent the evolution of the relationship.

Comparison of survival between adolescent and young adult vs older patients with hepatocellular carcinoma

BACKGROUND Due to the special clinical features and biologic characteristics of adolescent and young adult(AYA)cancers,AYA cancers are different from cancers in children and elderly individuals.However,there are few reports on AYA hepatocellular carcinoma(HCC).AIM To investigate the overall survival(OS)of AYA(15-39 years)and elderly(40-74 years)patients with HCC.METHODS The data of all the HCC cases were extracted from the Surveillance,Epidemiology,and End Results database from 2004 to 2015 and were then divided into two groups based on age:AYA group(15-39 years)and older group(40-74 years).Kaplan-Meier curves and log-rank tests were used to compare the OS of the two groups.Propensity score matching(PSM)was employed to analyze the OS difference between the two groups.The Cox proportional hazards regression model was used to perform multivariate analysis to explore the risk factors for OS of HCC patients.RESULTS Compared to elderly cancer patients,AYA patients with HCC had a worse Surveillance,Epidemiology,and End Results stage,including the distant stage(22.1%vs 15.4%,P<0.001),and a more advanced American Joint Committee on Cancer(AJCC)stage,including AJCC III and IV(49.2%vs 38.3%,P<0.001),and were more likely to receive surgery(64.5%vs 47.5%,P<0.001).Before PSM,the AYA group had a longer survival in months(median:20.00,interquartile range[IQR]:5.00-62.50)than the older group(median:15.00,IQR:4.00-40.00)(P<0.001).After PSM,the AYA group still had a longer survival in months(median:21.00,IQR:5.00-64.50)than the older group(median:18.00,IQR:6.00-53.00)(P<0.001).The Cox proportional hazards regression model showed that advanced age(hazard ratio[HR]=1.405,95%CI:1.218-1.621,P<0.001)was a risk factor for OS of HCC patients.In the subgroup analysis,the Cox proportional hazards regression model showed that in AJCC I/II HCC patients,advanced age(HR=1.749,95%CI:1.352-2.263,P<0.001)was a risk factor for OS,while it was not a risk factor in AJCC III/IV HCC patients(HR=1.186,95%CI:0.997-1.410,P=0.054)before PSM.After PSM,advanced age(HR=1.891,95%CI:1.356-2.637,P<0.001)was still a risk factor for OS in AJCC I/II HCC patients,but was not a risk factor for OS in AJCC III/IV HCC patients(HR=1.192,95%CI:0.934-1.521,P=0.157)after PSM.CONCLUSION AYA patients with HCC have different clinical characteristics from older adults.In different AJCC stages,the two groups of patients have different OS:In AJCC I/II HCC patients,advanced age is a risk factor for OS,but it is not a risk factor for OS in the AJCC III/IV HCC patient group.