Page 17 - Delaware Medical Journal - November/December 2020

ORIGINAL RESEARCH
Figure 1-2 Five-Year Average, Age-Adjusted All-Site Cancer Mortality Rates by Sex and Race/Ethnicity; U.S. and Delaware, 2011-2015
Source (Delaware): Delaware Department of Health and Social Services, Division of Public Health, Delaware Health Statistics Center, 2018. Source (U.S.): Surveillance, Epidemiology and End Results Program (SEER 18), National Cancer Institute, Nov 2017 Sub.
Rates are per 100,000 of population age-adjusted to the 2000 U.S. standard population.
cancer treatment. Maintaining a seamless educational trajectory is often crucial for adolescents, as schooling is a time of social engagement and allows for one to develop a sense of self- worth. Missing schoolwork can also delay future career or further education plans.3 The psychological impact of a cancer diagnosis is also different on AYAs compared to children. Several studies have demonstrated that AYAs have the cognitive ability to understand the severity of their illness, which often causes significant distress.3 Overall, these psychosocial needs differ from their younger counterparts and highlight the need for an
integrative approach when treating this particular group of patients.
Many AYAs are entering the health care system during this period of transition in their lives, as they
are becoming independent of their parents.11 Barriers to appropriate care may be due to age, lack of maturity, and lack of experience managing their own health care needs.9 In addition, it has been reported that North American AYA minority groups (e.g. Native Americans, African Americans, and Hispanics) are more likely to note difficulties obtaining financial support, difficulties accessing cancer services,
and failure to receive information related to concerns of relapse.9 These issues related to access of care continue through the period of survivorship, when follow-up appointments with various specialists are crucial for monitoring late-term effects related
to cancer treatment.11 Keegan et al. evaluated barriers to medical care among AYA cancer survivors and found that high cost and lack of insurance contributed to patients not receiving care.11 Efforts have been made to improve insurance rates under the Affordable Care Act, but access to health care remains an issue among the AYA population.2
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