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Case history

Image not available. A 23-year-old Polish woman presented as an emergency with back pain and was found to be in urinary retention. Investigations showed a large pelvic mass and innumerable lung metastases that were shown on biopsy to be a form of rhabdomyosarcoma. She was admitted for emergency chemotherapy to the regional teenage and young adult (TYA) unit. The intense chemotherapy regimen of ifosfamide, vincristine, dactinomycin and doxorubicin (IVADO), and vincristine, ifosfamide, doxorubicin and etoposide (VIDE) has a rapid induction and then runs over a 6 month period. The regimen is highly challenging, with immediate implementation and long periods of inpatient admission; it is very commonly associated with multiple complications such as neutropenic sepsis.

From the initial encounter there were significant barriers to communication, and a lability of engagement associated with fluctuation in mood, acceptance of therapy and interaction with the TYA cancer medicine team. There were additional challenges given the differences in cultural customs in the UK compared with Poland and while there was not an apparent language barrier in this case the difference in approach posed significant challenges for our patient.

As her treatment continued it emerged that there were numerous events occurring within her family and social setting that were affecting her acceptance and engagement with treatment. This led to variable compliance with significant medications and manifestation of a, likely premorbid, eating disorder which contributed to deterioration of her performance status. These events also significantly limited her ability to cope with her diagnosis and treatment, and the impact intense chemotherapy was having on her life and relationships.

She had ongoing input from an experienced TYA multidisciplinary team (MDT) throughout her treatment, which proved invaluable, and through provision of support from multiple avenues she was able to optimize her experience of treatment and work through the external issues that were having such a significant impact on her throughout treatment.

Background

Why are psychosocial issues commonly seen in TYA patients with cancer?

What steps can be taken to support TYA patients?

What is the role of the MDT?

How is depression in children and young people managed?

Background

Cancer in young people is rare. The incidence in the UK is 269 cases per million young people (aged 16–24 years), which accounted for 2214 new cases of cancer between 2008 and 2010.1 The needs of young people are significant and diverse, and require specific input, therapy management structures and support mechanisms. This is particularly the case as they are, as a group, generally looked after within the adult healthcare sector. These requirements have been embedded within the NHS via the production and implementation of NICE guidance.1,2

Why are psychosocial issues commonly seen in TYA patients with cancer?

During their formative years teenagers and young people develop extensively not only physically but also emotionally, socially and psychologically. Even in the absence of a cancer diagnosis, it is ...

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