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NCCN Flash Updates: NCCN Guidelines^® Updated for Adolescent and Young Adult Oncology

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Adolescent and Young Adult Oncology. These NCCN Guidelines^® are currently available as Version 1.2021.

• Purpose of the NCCN Guidelines for AYA Oncology (AYAO-1)
  • Removed the following statement: 
    • The goal of the NCCN Guidelines for AYA Oncology is to identify issues specific to the AYA population; recommend interventions unique to the AYA population; educate physicians regarding the prevalence of cancer in AYAs; discuss long-term consequences; explain special considerations related to cancer management in AYA patients that aim to improve treatment tolerance, compliance, and clinical outcomes; and promote participation in clinical trials.
  • Replaced footnote c with the following reference: See Age-Specific SEER Incidences of Cancer by Age Group and Sex in the AYA Population (2012–2016) (AYAO-A). Howlader N, Noone AM, Krapcho M, et al Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2017, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2017, based on November 2019 SEER data submission, posted to the SEER web site, April 2020.
• Treatment-Related Issues (AYAO-4)
  • Toxicities, added recommendations for:
    • Ototoxicity -Routine evaluations for tinnitus and periodic audiogram to monitor hearing loss associated with cisplatin- or carboplatin-based chemotherapy
    • Neurotoxicity - Routine evaluation for symptoms of peripheral neuropathy.
• Fertility and Reproductive Endocrine Considerations (AYAO-5)
  • Added recommendations:
    • Consider the emotional impact of conversations surrounding fertility preservation, especially for the younger AYA patient.
    • Provide AYA patients with financial resources for fertility preservation (AYAO-9)
  • Males
    • Modified: Discuss testicular sperm extraction and electroejaculation as options if the patient has medical, religious, emotional, or developmental issues that preclude traditional sperm banking
    • Modified: Discuss fertility implications and sexuality during and after treatment and the option of testing for fertility with semen analysis. Consider referral to fertility specialist as appropriate.
    • Added: Discuss effects of treatment on sexual function during and after treatment. Consider referral to fertility specialist as appropriate.
  • Females
    • Modified: Discuss fertility implications and sexuality during and after treatment and the importance of follow-up with a gynecologist or fertility specialist to monitor ovarian function over time.
    • Added: Discuss effects of treatment on sexual function during and after treatment. Consider referral to specialist as appropriate.
  • Added footnote: Fertility and Sterility® Vol. 100, No. 5, November 2013 0015-0282. Copyright ©2013 American Society for Reproductive Medicine, Published by Elsevier Inc. http://dx.doi.org/10.1016/j.fertnstert.2013.08.012.  
• Psychosocial/Behavioral Considerations: 
  • Individual (AYAO-6) 
    • Supportive Care Services/Interventions, added new bullets: 
    • If Child Life Specialists are present on the unit, have them meet with the patient soon after diagnosis to address concerns that the patient has regarding treatment or procedures, as well as assist with coping mechanisms to reduce anxiety related to procedures.
    • For LGBTQ AYA, offer additional psychosocial supports and referrals if they are experiencing stressors, stigma, or rejection related to their sexuality or gender identity.
    • For transgender youth, consider referral to a specialized gender clinic for psychosocial supports and coordination of gender-affirming medical care.
  • Socioeconomic (AYAO-9)
    • Added bullet: Encourage discussion with guidance counselors and educators about impact of cancer care on education.
• Survivorship (AYAO-10 and AYAO-11)
  • Removed text from AYAO-10 and included in Exposure and Recommendations table on AYAO-11.
• Disease-Specific Issues Related to Age (AYAO-A)
  • Removed the table: Age-Specific SEER Incidences of Cancer by Age Group and Sex in the AYA Population 
  • Added bullet: Referral to an institution with multidisciplinary expertise in the management of sarcomas is strongly recommended. (also applies to bullet for Rhabdomyosarcoma)
  • Added  a reference: Ahmed SK, Randall RL, DuBois SG, et al. Identification of Patients With Localized Ewing Sarcoma at Higher Risk for Local Failure: A Report From the Children's Oncology Group. A Int J Radiat Oncol Biol Phys. 2017;99:1286-1294.
• Screening Recommendations for AYA Survivors (AYAO-B)
  • This section has been updated, including the Assessment for Gonadal Function section which has undergone extensive revision
• Online Resources (AYAO-D), added: Gilda's Club, free nonprofit emotional and social support community for people living with cancer, and their families and friends. https://www.cancersupportcommunity.org
• Discussion (MS-1)
  • The Discussion section has been updated to reflect the changes in the algorithm.

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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