Optimising Adolescent and Young Adult Cancer Care

Alignment with the Optimal Care Pathway and Development of a Coordinated Multidisciplinary Approach. A partnership approach with SMICS, PICS and GRICS

Adolescent and Young Adult (AYA) patients with a diagnosis of cancer have complex and unique medical and psychosocial needs. It is well recognised that a multidisciplinary, age and developmentally targeted approach to care is needed for this population, with access to psychosocial support, allied health, clinical trials, educational/vocational support and fertility preservation.

This has been recognised with the development of the Australian Youth Cancer Framework, the AYA cancer Optimal Care Pathways (OCPs) published earlier this year, and the establishment of the nationwide Youth Cancer Service, designed to support cancer care for 15-25 year old’s in Australia. Currently the only specific Youth Cancer Service in Victoria is the ONTrac program, run through the Peter MacCallum Cancer Centre. While ONTrac provides an important service for the state, it is unable to adequately or locally meet the care needs of patients in the Monash Health catchment, or Gippsland region.

Monash Health is in an ideal and somewhat unique position to develop a world class service to meet AYA needs, as it is the only health service in Australia where all of the necessary teams and expertise are under the same organisational governance. To this end, an AYA cancer working group has been formed by clinicians and nursing staff from the Monash Children’s Cancer Centre as well as Monash Health adult Haematology and Oncology teams, to address a clinical need to develop a specialised and integrative AYA cancer service at Monash Health. Both SMICS and PICS continue to provide important contributions to these working group meetings.

While significant AYA expertise exists across pediatric and adult cancer services at Monash Health, there currently is not a coordinated uniform approach to assess and address the specific psychosocial and supportive care needs of these patients. As a result, there is significant variability in the quality of AYA directed care and the care needs of many AYAs are not adequately met. This is exacerbated by the vast geographical size of the Monash Health network and lack of shared internal screening tools, protocols and documented referral pathways.

Targeted AYA services in the Gippsland region are not available, with additional challenges to providing high quality care close to home due geography and care delivery through multiple independent healthcare networks and community providers.

The AYA Cancer OCP is a framework for the delivery of consistent, safe, high-quality and evidence-based care for young people with cancer was released earlier this year. In defining best practice, the recent publication of the OCP gives us an opportunity to benchmark current AYA cancer care delivered across departments and campuses and design a coordinated sustainable approach to improve patient outcomes and experiences. This project will focus on a cohort of 15–30-year old’s, in line with international definitions of “AYA”, as the 25-30yo subgroup has also been identified as a vulnerable population.