Exploring two decades of cancer trends in adolescents and young adults: Insights from a resource-restricted country.

Abstract

11058 Background: Over 40% of the Jordan population are adolescents and young adults (AYA), aged 15-39 years. Cancer diagnoses in this age group have distinct clinical characteristics and patients face unique needs and psychosocial challenges. We present data on local trends in cancer diagnoses among AYA, and their treatment outcomes. Methods: We utilized reports from the Jordan Cancer Registry (JCR) and the King Hussein Cancer (KHCC) registry to obtain treatment outcomes. Results: During 2022 a total of 8,754 new cancer cases were reported by the JCR; 4,736 (54.1%) were females and the median age at diagnosis was 57 years. Only 312 (3.6%) of the cases were diagnosed in childhood age group (<15 years), while 1,167 (13.3%) cases were diagnosed among AYA (15-39 years) and most of these cases (36.8%) were among the older AYA subgroup (35-39 years). Over the past 22 years, the total number of reported cancer cases among AYA has almost doubled from 654 in 2000 to 1,167 cases in 2022. Hodgkin’s lymphoma (13.6%), testicular cancer (12.2%), non-Hodgkin’s lymphoma (NHL) (10.9%), colorectal cancer (10.0%) and acute leukemia (9.8%) were the most encountered tumors in males, while breast cancer (31.5%), thyroid cancer (15.4%), Hodgkin’s lymphoma (7.2%), colorectal cancer (6.2%) and ovarian cancer (5.5%) were the most common cancers in females in the AYA group. In the childhood age group, acute leukemia (24.4%) and brain tumors (20.2%) were the two most common cancers, accounting for almost half of all tumors in this group. The age-standardized incidence rate (ASIR) was higher among females compared to males across all age subgroups within the AYA. Such difference is more evident within the “older” group (30-34) years (64.3 versus 35.0) and in the (35-39) years age group (116.1 versus 52.3). These differences may be attributed to breast, and to a lesser extent thyroid cancer. Additionally, the ASIR increases with increasing age within the AYA age group; rates increased from 17.3 (15-19 years) up to 84.4 in the (35-39 years) group. Survival data on 7,202 AYA cancer patients treated and followed-up at KHCC were obtained from its hospital-based cancer registry. The 5-year overall survival was 73.0% (95% CI, 71.8-74.1), better than 57.1% (95% CI, 56.4-57.8) among 26,604 older adults (>39 years old), and lower than 75.2% (95% CI, 73.6%-76.9%) among 3,031 pediatric patients (<15 years) treated during the same period, p<0.0001. Conclusions: Over 40% of the Jordanian population is within the AYA age group. Though the cancer incidence is lower, and overall survival is better in this age group compared to older adults, a comprehensive plan that values the special physical and psychosocial needs of this group of patients should be addressed. Establishing a specialized AYA program with specialized ancillary services addressing these issues, especially those related to late treatment effects, is a national health care priority.