Cancer care for adolescents and young adults in Jordan

Background: Adolescents and young adults with cancer have special characteristics and needs.

Aims: This study highlighted psychosocial challenges, fertility issues and secondary diseases encountered in adolescents and young adults with cancer. This work is meant to be a platform for future interventions for cancer in this demographic.

Methods: We investigated the latest edition of the Jordan Cancer Registry [JCR] and our more comprehensive institutional database during 2000–2012. Smoking, obesity and fertility preservation were addressed briefly as important issues among AYA patients.

Results: Cancer among adolescents and young adults represents 16.3% of all new cancer cases and has increased by 25% over the past 12 years. Women are more likely to be involved [female: male ratio of 1.44: 1] because of thyroid and breast cancers. Five-year survival rate for the AYA group was 72.4%, which was significantly better than for adults aged . 40 years [59.8%] but worse than for paediatric patients aged < 15 years [79.2%] [P < 0.0001].

Conclusions: Cancer in adolescents and young adults represents a substantial and growing proportion of oncological diagnoses. Due to their special needs and treatment complications, a dedicated service is urgently needed.

Cancer care in Jordan

Cancer is the second leading cause of death in Jordan after cardiovascular diseases. Due to increase in life expectancy and prolonged exposure to risk factors, cancer mortality and morbidity are expected to increase as the young population ages. This increase will constitute a challenging burden on healthcare systems in Jordan and many other neighboring countries. Planning is key to managing the expected rise in the demand for cancer care, and this will require public health initiatives to guarantee access to quality cancer care. Over the past decade, cancer care in Jordan has witnessed remarkable improvement through access to advanced diagnostics and therapeutics. In this review, we address the history of cancer care in Jordan, including cancer statistics, infrastructure, workforce as well as cancer care outcomes. We also discuss many of the challenges that we face and offer suggestions for the improvement of cancer management in Jordan and the region

Inferior vena cava filters in patients with advanced-stage cancer

Cancer and its treatment are recognized risk factors for venous thromboembolism [VTE]. Inferior vena cava [IVC] filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism [PE] or to avoid bleeding from systemic anticoagulation. A retrospective analysis of 107 cancer patients who had IVC filters inserted and followed up at our institution was performed. All patients had active cancer; a majority [> 90%] had advanced-stage disease, whereas only five patients [5.8%] had stages I or II disease. Eighty six patients [80.3%] had their IVC filter placed through a jugular approach. Filter insertion was not without complications; recurrent deep vein thrombosis [DVT] was reported in 10 [9.3%], PE in three [2.8%] and filter thrombosis in one patient. The value of IVC filter in patients with advanced stage disease was very limited: among 59 patients with stage IV disease for whom survival data was available, the median survival was only 1.31 months [0.92-2.20] with 23 patients [39.0%] surviving less than a month, and 40 [67.8%] surviving less than three months. Systemic anticoagulation can be safely offered for the majority of cancer patients. When the risk of bleeding or PE is high, IVC filters can be utilized. However, the placement of such filters should take into consideration the stage of disease and life expectancy of such patients. Patients with advanced-stage disease may gain little benefit from IVC filter insertion