Experience in the Approach to Adolescents with Cancer in a Multidisciplinary Unit. Growing Together

Experience in the Approach to Adolescents with Cancer in a Multidisciplinary Unit. 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Growing Together Belén Huguet Rodríguez, Pablo González Navarro, Perceval Vellosillo González, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6767305/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Jan, 2026 Read the published version in European Journal of Pediatrics → Version 1 posted 11 You are reading this latest preprint version Abstract INTRODUCTION: Over the past few years, there has been growing concern about the treatment and management of adolescents and young adults (AYA) with cancer, due to the unique characteristics of these patients transitioning to adulthood and the lack of progress in improving survival compared to younger patients. The main objective of the study is to analyze the epidemiology and overall survival of the adolescent patient cohort at Gregorio Marañón Hospital since the creation of the Adolescent Unit. RESULTS AND DISCUSSION: A study was conducted in the Adolescent Unit of the Gregorio Marañón Hospital, analyzing epidemiology and survival. A total of 111 patients were included, with a wide variety of diagnoses, with lymphomas being the most frequent pathology. The 5-year survival rate was 73%. Pediatric treatment protocols were used in 77% of the patients, and fertility preservation techniques were performed in 25% of the cases. CONCLUSIONS: The Adolescent Unit undertakes a multidisciplinary approach to adolescents and it is necessary to improve the factors that allow an increase in survival and quality of life. adolescents AYA survival oncology epidemiology Figures Figure 1 Figure 2 Figure 3 Figure 4 1. INTRODUCTION Adolescents and young adults (AYA), an age group ranging from 15 to 39 years old, with cancer constitute a set of patients with unique epidemiology and social, physical, cognitive, and emotional needs [ 1 – 2 ]. These patients have specifics requirements to their age group, such as adapting information according to their age, providing information on fertility preservation, and understanding the long-term impact of the oncological process and its treatment [ 2 – 4 ]. Since the second half of the 20th century, there has been a significant improvement in childhood cancer survival. However, this increase in survival has not been as pronounced in the adolescent and young adult group, due in part to biological factors, lower participation in clinical trials, among others reasons [ 2 , 5 , 6 ]. Given this, in recent years, there has been growing global concern within the scientific community regarding the treatment and management of this group of patients. The lack of appropriate treatments protocols specifically designed for this patient group has led to the emergence of dedicated working groups to address their needs [ 7 – 11 ]. In this context, Spain’s first comprehensive care units for adolescents with cancer were established in 2018 under the Spanish Sociecty of Pediatric Hematology and Oncology (SEHOP), with the Community of Madrid pioneering this initiative [ 12 ]. Among these, the Adolescent Unit at Hospital General Universitario Gregorio Marañón was one of the earliest specialized centers dedicated to the holistic management of adolescent cancer patients. The main objective of the study is to analyze the epidemiology and overall survival of the adolescent patient cohort since the creation of this unit. 2. MATERIALS AND METHODS A descriptive and observational prospective study was conducted to analyze the epidemiology and overall survival of patients in the Adolescent Oncohematology Unit at the Gregorio Marañón General University Hospital. Patients aged 14 years and older who were admitted to the Unit with an oncological diagnosis (including solid and hematological tumors) were included. Data were collected from January 2018 to May 2023. The data source used to create the database was the electronic medical record. Statistical analysis was performed using R Statistical Software (version 4.3.1; R Foundation for Statistical Computing, Vienna, Austria). Absolute and relative frequencies were used for qualitative variables. Quantitative variables were reported as median and interquartile range, as well as mean and standard deviation. Associations of interest between qualitative variables were analyzed using Fisher's exact test. The probability of survival over the follow-up period was described using Kaplan-Meier curves, stratified by different groups of interest. Hypothesis testing between survival curves was performed using the log-rank test. Statistical significance was considered for hypothesis tests with p < 0.05. 3. RESULTS A total of 111 patients were included, with their epidemiological characteristics presented in Table 1. Of these, 58% were referred from outside the Gregorio Marañón catchment area for evaluation at this center. Tumor classification was based on a modified version of the Barr system, which proposes a framework for categorizing tumors in the adolescent and young adult (AYA) population [ 13 ]. The most frequent diagnosis was lymphoma, accounting for 23% of the cohort, of which 73% were Hodgkin lymphoma. The second most common diagnostic group was bone tumors, representing 20% of the sample, with Ewing sarcoma and osteosarcoma being the most prevalent within this category. Central nervous system (CNS) tumors followed, comprising 15% of cases (including gliomas, medulloblastoma, craniopharyngioma, ependymoma, among others), followed by leukemias and related disorders at 14% (most cases were B- and T-cell acute lymphoblastic leukemia, acute myeloid leukemia, one case of myelodysplastic syndrome, and one of histiocytosis). Gonadal tumors accounted for 13%, most of which were germ cell tumors. Carcinomas made up 9% of cases (including gastrointestinal stromal tumor (GIST), nasopharyngeal carcinoma, parotid carcinoma, pancreatic carcinoma, and thyroid carcinoma). Finally, soft tissue sarcomas represented 4.5% of the sample. The different treatment regimens are summarized in Table 2. Massive parallel sequencing studies using NGS (Next Generation Sequencing) panels to detect germline mutations associated with cancer predisposition syndromes were performed in 66% patients. Pathogenic mutations were identified in 11% of the patients analyzed, mutations were found in the following genes: DICER1, MUTYH, RECQL4, CHEK2, TERT, and CARD11. These patients were referred to a hereditary cancer unit. Additionally, NGS somatic panels were performed in 25% of the patients, identifying alterations in the following genes and pathways: SHH, CTL-ALK, EWSR1 fusions (Ewing), ALK+, BRAF, NRAS, and the KIAA1549-BRAF fusion. Fertility preservation was indicated in 40% of the sample. Among these patients, fertility preservation techniques were implemented in 63% of cases. Among those who did not undergo such procedures, 42% were informed about the availability of fertility preservation programs. Reasons for not pursuing fertility preservation included clinical contraindications at diagnosis, poor tumor prognosis, or refusal by the patient and/or family. The types of preserved material included semen in 14% (15 patients), oocytes in 11% (12 patients), ovarian tissue in 0.9% (1 patient), and failed procedures in 1.8% (2 patients). Overall survival (OS) for the cohort was 93% at 1 year and 73% at both 5 and 7 years (Fig. 1). No statistically significant differences in survival were observed between male and female patients (Fig. 2). Statistically significant differences in event-free survival (EFS) were found based on the type of treatment protocol used. Patients treated under adult protocols showed improved EFS compared to those treated under pediatric protocols. The lowest survival rates were observed in patients who did not receive a defined treatment protocol (Fig. 3). Survival also varied significantly by diagnostic group. The lowest survival was seen in patients with soft tissue sarcomas, followed by those with bone tumors. The highest survival rate was observed in the gonadal tumor group, with a 100% survival rate (Fig. 4). Targeted therapies were administered to 20% of patients, guided by the genetic and molecular alterations detected in the tumor and 17% of patients who relapsed were enrolled in clinical trials as first-line treatment for relapse. 4. DISCUSION The distribution of different pathologies in the sample is consistent with other epidemiological studies in AYA populations [ 1 , 14 , 15 ], with lymphomas—particularly Hodgkin lymphoma—emerging as the predominant group. Compared to the pediatric age group, the proportion of leukemias and CNS tumors decreases. Bone tumors, characteristic of the AYA population, and gonadal tumors also appear. The proportion of carcinomas is low, likely due to the predominance of adolescent patients in the sample, with a mean age of 14.62 years; these tumors are more frequently observed in older patients [ 2 , 14 , 15 , 16 ]. The fact that improvements in childhood cancer survival have not had as significant an impact on adolescent populations has been the subject of study in recent years [ 2 , 5 , 6 , 17 ]. Several contributing factors have been identified, including biological differences, diagnostic delays, and poor treatment adherence [ 5 ]. One key determinant of poorer outcomes is the lower participation of adolescents in clinical trials [ 2 , 5 , 17 , 18 , 19 ], as observed in our study, in which only 17% of patients who relapsed were enrolled in clinical trials as first-line treatment for relapse. Reasons for the low participation rate among AYA patients include, among others, the scarcity of trials targeting AYA-specific tumors; restrictive age eligibility criteria, which often exclude adolescents and younger AYAs; and limited awareness among treating physicians regarding available clinical trials [ 2 , 19 ]. The inclusion of adolescents in clinical trials is crucial for improving both care and survival in this patient group. Therefore, continued investigation into the factors contributing to the underrepresentation of this group, as well as efforts to enhance their recruitment and participation, is essential [ 20 , 21 ]. In recent years, it has been demonstrated that the use of pediatric treatment regimens in adolescents and younger AYAs leads to improved survival outcomes [ 5 , 22 , 23 , 24 ]. Notably, in the studied sample, the group treated with adult protocols achieved a significantly higher event-free survival. This finding may be explained by the fact that the patients treated with adult protocols had more favorable prognostic factors, including localized tumors and histological subtypes associated with better outcomes, potentially acting as a confounding factor. The overall five-year EFS rate in this cohort was 73%. This rate is lower than that reported in other epidemiological studies in AYAs [ 6 , 8 , 18 , 22 , 25 , 26 ]. Several factors may contribute to this difference, including the fact that the comparison studies were multicenter, international observational studies with significantly larger sample sizes, longer follow-up periods, and consequently, reduced risk of bias. Furthermore, the development of AYA units in Spain is relatively recent in comparison with other European countries and the United States. Additionally, poorer survival outcomes in our cohort may be associated with the fact that 15% of patients were already in relapse at the time of admission, 6.4% were undergoing second-line treatment, and 5.5% were on third-line therapy or beyond. There was also a higher proportion of patients with bone and soft tissue sarcomas, considering that these tumors are associated with low survival rates [ 27 ]. Moreover, 58% of the patients were referred from outside the Gregorio Marañón area, often after failing initial therapy, thus presenting with more advanced or refractory disease. A key issue for cancer survivors of reproductive age is fertility preservation. This should be a priority within AYA-specific programs and services [ 2 , 28 , 29 , 30 ]. In the present review, the proportion of patients who underwent fertility preservation procedures was low compared to the literature [ 31 ]. Efforts should be made to improve this percentage, ensuring that, whenever the patient’s clinical status allows, age- and culturally appropriate information is provided to patients and their families. A significant proportion of AYA cancer patients harbor germline mutations, which are important for prognosis, treatment decisions, risk of second malignancies, and family counseling [ 32 ]. In our sample, NGS panel testing was performed in 66% of patients, revealing pathogenic or likely pathogenic mutations in 10% and variants of uncertain significance in 1.4%, consistent with data reported in the literature [ 32 , 33 ]. In conclusion, the Gregorio Marañón Unit provides multidisciplinary care that addresses the specific needs of adolescents with cancer, offering age-appropriate educational and psychosocial support, as well as collaboration with medical oncology, thereby addressing concerns related to the management of these patients and the survival gap observed when compared to pediatric populations. There is a pressing need to address modifiable factors that impact survival, such as increasing participation in clinical trials, optimizing the use of genomic diagnostic tools to enhance tumor characterization in this population, and ensuring the implementation of long-term follow-up programs to reduce morbidity among adolescent cancer survivors. Multicenter studies involving the various specialized units across the Community of Madrid and nationally are essential. Improved diagnostic reporting in this age group is key to better understanding the current situation of adolescent patients in Spain and to identifying areas for improvement. In this regard, the creation of a unified national registry would allow for earlier implementation of improvements and greater insight into cancer in adolescents. Abbreviations -AYA: Adolescents and Young Adults -CNS: Central nervous system -EFS: event-free survival EFS -GIST: Gastrointestinal Stromal Tumor -IOR: intraoperative radiotherapy -NGS: Next Generation Sequencing -OS: Overall survival -SEHOP: Spanish Society of Pediatric Hematology and Oncology -STS: Soft Tissue Sarcoma Declarations STATEMENTS AND DECLARATIONS The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. COMPETING INTERESTS The authors declare that they have no competing interests, financial or non-financial, related to the content of this manuscript. AUTHOR CONTRIBUTIONS All authors contributed to the study conception and design. Material preparation, data collection by Belén Huguet and Carmen Garrrido, analysis were performed by Pablo Gónzalez and Perceval Vellosillo. The first draft of the manuscript was written by Belén Huguet and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. ETHICAL CONSIDERATIONS The study was conducted in accordance with the legislation, following Organic Law 3/2018 on Personal Data Protection and Guarantee of Digital Rights, as well as Regulation (EU) 2016/679 of the European Parliament and Council of April 27, 2016, on Data Protection (GDPR). It also adhered to the basic principles of bioethics established in the Belmont and Helsinki Declarations. The study was reviewed and approved by the Research Ethics Committee (Comité de Ética de la investigación con medicamentos Hospital General Universitario Gregorio Marañón). 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Lancet Child Adolesc Health. ;5(2):142–154. 10.1016/S2352-4642(20)30275-3 . PMID: 33484663 Tables N=111 SEX Male 63 57% Female 48 43% AGE Mean(SD) 14.62 (2.04) Median(IQR) 15.00 (13.00, 16.00) Range 10.00,22.00 EXTENT OF DISEASE AT DIAGNOSIS Localized 49 45% Metastasic 49 45% Not assesable 11 10% CLINICAL STATUS AT DIAGNOSIS De novo diagnosis 91 83% Relapse 17 15% Under follow up 2 1.8% Table 1. Epidemiological characteristics of the studied sample. Data are presented as absolute frequencies and percentages for qualitative variables. Quantitative variables are described using the median and interquartile range, as well as the mean and standard deviation. LINE OF TREATMENT First 97 88% Second 7 6.4% Other 6 5.5% PROTOCOL TYPE Pediatric 85 77% Adult 11 10% No established protocol 14 13% HEMATOPOIETIC STEM CELL TRANSPLANTATION Yes 15 14% No 95 86% TARGETED THERAPY Yes 22 20% No 88 80% RADIOTHERAPY Yes 27 25% No 83 75% TYPE OF RADIOTHERAPY Photons 22 71% Protons 6 19% I.O.R (Intraoperative Radiotherapy) 2 10% CLINICAL STATUS Remission 81 75% Disease 9 8.3% Death 18 16% CAUSE OF DEATH Disease 16 94% Toxicity 1 5.9% Table 2. Treatments Used and Status After Treatment Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Jan, 2026 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 30 Oct, 2025 Reviews received at journal 29 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers agreed at journal 26 Sep, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviewers invited by journal 15 Jun, 2025 Editor assigned by journal 14 Jun, 2025 Submission checks completed at journal 14 Jun, 2025 First submitted to journal 28 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6767305","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472059637,"identity":"977e829e-d591-43c5-9c1e-207179a7f304","order_by":0,"name":"Belén Huguet Rodríguez","email":"","orcid":"","institution":"Atención Primaria Centro de Salud General Ricardos. Madrid","correspondingAuthor":false,"prefix":"","firstName":"Belén","middleName":"Huguet","lastName":"Rodríguez","suffix":""},{"id":472059638,"identity":"c5f962a8-9f29-4dbd-b332-19216fe1876e","order_by":1,"name":"Pablo González Navarro","email":"","orcid":"","institution":"Unidad de Investigación Materno Infantil - Fundación Familia Alonso (UDIMIFFA) - Instituto de Investigación","correspondingAuthor":false,"prefix":"","firstName":"Pablo","middleName":"González","lastName":"Navarro","suffix":""},{"id":472059639,"identity":"2e2e9c6e-14b1-4251-832d-0fdffb7331df","order_by":2,"name":"Perceval Vellosillo González","email":"","orcid":"","institution":"Unidad de Investigación Materno Infantil - Fundación Familia Alonso (UDIMIFFA) - Instituto de Investigación","correspondingAuthor":false,"prefix":"","firstName":"Perceval","middleName":"Vellosillo","lastName":"González","suffix":""},{"id":472059640,"identity":"b57d7573-3256-444d-8710-f22533cdad5f","order_by":3,"name":"Carmen Garrido Colino","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYNACAwlmflK1WLBLNpCop4Lf4ACxanX7Fz/7XFEgIW18I/npBoaKOsJazG48M555xkDC2OxGmtkNhjOHidFywJixwUAi2exGDtsNxjYinGd24/hnkJb6zTNAWv4R47DzPWBbmA0kQFoamImxhacYrEXizDOzGwnHiPHL+eObGRv+1DHztyc/u/GhhgiHMUgkIHEScChCBfwHiFI2CkbBKBgFIxkAAHDjOLEKmqGlAAAAAElFTkSuQmCC","orcid":"","institution":"Oncología -Hematología Pediátrica Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid. Madrid","correspondingAuthor":true,"prefix":"","firstName":"Carmen","middleName":"Garrido","lastName":"Colino","suffix":""}],"badges":[],"createdAt":"2025-05-28 10:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6767305/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6767305/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00431-026-06747-3","type":"published","date":"2026-01-19T15:57:12+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84870799,"identity":"7bd869e1-2931-4ed1-a821-fbfefa0686e0","added_by":"auto","created_at":"2025-06-18 09:00:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148728,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOVERALL SURVIVAL\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6767305/v1/7adb5aafcb92fe56fd71e260.png"},{"id":84870800,"identity":"7eb95cf3-ad74-4a75-913a-f431c7678fe9","added_by":"auto","created_at":"2025-06-18 09:00:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":178440,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvent-free survival according to sex\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6767305/v1/6642abd2fd96e5e95403f6a3.png"},{"id":84871572,"identity":"19982fb2-1dad-48fe-9009-d2a306f87fd4","added_by":"auto","created_at":"2025-06-18 09:08:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":277214,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvent-free survival by treatment protocol\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6767305/v1/687acc6bac13d0f6a49881b0.png"},{"id":84870804,"identity":"91ebb872-ae23-4bc6-83b0-8b870243794c","added_by":"auto","created_at":"2025-06-18 09:00:15","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":412240,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEvent-free survival according to diagnosis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6767305/v1/54f11a782d27eccb3af5449a.png"},{"id":101151833,"identity":"36e79fcc-5982-482d-b99f-00f873d3cbc4","added_by":"auto","created_at":"2026-01-26 16:06:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1478348,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6767305/v1/bbf276fd-ba5d-4ab5-84ae-99039fb1f1e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experience in the Approach to Adolescents with Cancer in a Multidisciplinary Unit. Growing Together","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eAdolescents and young adults (AYA), an age group ranging from 15 to 39 years old, with cancer constitute a set of patients with unique epidemiology and social, physical, cognitive, and emotional needs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These patients have specifics requirements to their age group, such as adapting information according to their age, providing information on fertility preservation, and understanding the long-term impact of the oncological process and its treatment [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince the second half of the 20th century, there has been a significant improvement in childhood cancer survival. However, this increase in survival has not been as pronounced in the adolescent and young adult group, due in part to biological factors, lower participation in clinical trials, among others reasons [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Given this, in recent years, there has been growing global concern within the scientific community regarding the treatment and management of this group of patients. The lack of appropriate treatments protocols specifically designed for this patient group has led to the emergence of dedicated working groups to address their needs [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this context, Spain\u0026rsquo;s first comprehensive care units for adolescents with cancer were established in 2018 under the Spanish Sociecty of Pediatric Hematology and Oncology (SEHOP), with the Community of Madrid pioneering this initiative [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Among these, the Adolescent Unit at Hospital General Universitario Gregorio Mara\u0026ntilde;\u0026oacute;n was one of the earliest specialized centers dedicated to the holistic management of adolescent cancer patients. The main objective of the study is to analyze the epidemiology and overall survival of the adolescent patient cohort since the creation of this unit.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cp\u003eA descriptive and observational prospective study was conducted to analyze the epidemiology and overall survival of patients in the Adolescent Oncohematology Unit at the Gregorio Mara\u0026ntilde;\u0026oacute;n General University Hospital. Patients aged 14 years and older who were admitted to the Unit with an oncological diagnosis (including solid and hematological tumors) were included.\u003c/p\u003e \u003cp\u003eData were collected from January 2018 to May 2023. The data source used to create the database was the electronic medical record. Statistical analysis was performed using R Statistical Software (version 4.3.1; R Foundation for Statistical Computing, Vienna, Austria). Absolute and relative frequencies were used for qualitative variables. Quantitative variables were reported as median and interquartile range, as well as mean and standard deviation. Associations of interest between qualitative variables were analyzed using Fisher's exact test.\u003c/p\u003e \u003cp\u003eThe probability of survival over the follow-up period was described using Kaplan-Meier curves, stratified by different groups of interest. Hypothesis testing between survival curves was performed using the log-rank test. Statistical significance was considered for hypothesis tests with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eA total of 111 patients were included, with their epidemiological characteristics presented in Table\u0026nbsp;1. Of these, 58% were referred from outside the Gregorio Mara\u0026ntilde;\u0026oacute;n catchment area for evaluation at this center.\u003c/p\u003e \u003cp\u003eTumor classification was based on a modified version of the Barr system, which proposes a framework for categorizing tumors in the adolescent and young adult (AYA) population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The most frequent diagnosis was lymphoma, accounting for 23% of the cohort, of which 73% were Hodgkin lymphoma. The second most common diagnostic group was bone tumors, representing 20% of the sample, with Ewing sarcoma and osteosarcoma being the most prevalent within this category. Central nervous system (CNS) tumors followed, comprising 15% of cases (including gliomas, medulloblastoma, craniopharyngioma, ependymoma, among others), followed by leukemias and related disorders at 14% (most cases were B- and T-cell acute lymphoblastic leukemia, acute myeloid leukemia, one case of myelodysplastic syndrome, and one of histiocytosis). Gonadal tumors accounted for 13%, most of which were germ cell tumors. Carcinomas made up 9% of cases (including gastrointestinal stromal tumor (GIST), nasopharyngeal carcinoma, parotid carcinoma, pancreatic carcinoma, and thyroid carcinoma). Finally, soft tissue sarcomas represented 4.5% of the sample.\u003c/p\u003e \u003cp\u003eThe different treatment regimens are summarized in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eMassive parallel sequencing studies using NGS (Next Generation Sequencing) panels to detect germline mutations associated with cancer predisposition syndromes were performed in 66% patients. Pathogenic mutations were identified in 11% of the patients analyzed, mutations were found in the following genes: DICER1, MUTYH, RECQL4, CHEK2, TERT, and CARD11. These patients were referred to a hereditary cancer unit. Additionally, NGS somatic panels were performed in 25% of the patients, identifying alterations in the following genes and pathways: SHH, CTL-ALK, EWSR1 fusions (Ewing), ALK+, BRAF, NRAS, and the KIAA1549-BRAF fusion.\u003c/p\u003e \u003cp\u003eFertility preservation was indicated in 40% of the sample. Among these patients, fertility preservation techniques were implemented in 63% of cases. Among those who did not undergo such procedures, 42% were informed about the availability of fertility preservation programs. Reasons for not pursuing fertility preservation included clinical contraindications at diagnosis, poor tumor prognosis, or refusal by the patient and/or family. The types of preserved material included semen in 14% (15 patients), oocytes in 11% (12 patients), ovarian tissue in 0.9% (1 patient), and failed procedures in 1.8% (2 patients).\u003c/p\u003e \u003cp\u003eOverall survival (OS) for the cohort was 93% at 1 year and 73% at both 5 and 7 years (Fig.\u0026nbsp;1). No statistically significant differences in survival were observed between male and female patients (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eStatistically significant differences in event-free survival (EFS) were found based on the type of treatment protocol used. Patients treated under adult protocols showed improved EFS compared to those treated under pediatric protocols. The lowest survival rates were observed in patients who did not receive a defined treatment protocol (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eSurvival also varied significantly by diagnostic group. The lowest survival was seen in patients with soft tissue sarcomas, followed by those with bone tumors. The highest survival rate was observed in the gonadal tumor group, with a 100% survival rate (Fig.\u0026nbsp;4). Targeted therapies were administered to 20% of patients, guided by the genetic and molecular alterations detected in the tumor and 17% of patients who relapsed were enrolled in clinical trials as first-line treatment for relapse.\u003c/p\u003e"},{"header":"4. DISCUSION","content":"\u003cp\u003eThe distribution of different pathologies in the sample is consistent with other epidemiological studies in AYA populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], with lymphomas\u0026mdash;particularly Hodgkin lymphoma\u0026mdash;emerging as the predominant group. Compared to the pediatric age group, the proportion of leukemias and CNS tumors decreases. Bone tumors, characteristic of the AYA population, and gonadal tumors also appear. The proportion of carcinomas is low, likely due to the predominance of adolescent patients in the sample, with a mean age of 14.62 years; these tumors are more frequently observed in older patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe fact that improvements in childhood cancer survival have not had as significant an impact on adolescent populations has been the subject of study in recent years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Several contributing factors have been identified, including biological differences, diagnostic delays, and poor treatment adherence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. One key determinant of poorer outcomes is the lower participation of adolescents in clinical trials [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], as observed in our study, in which only 17% of patients who relapsed were enrolled in clinical trials as first-line treatment for relapse. Reasons for the low participation rate among AYA patients include, among others, the scarcity of trials targeting AYA-specific tumors; restrictive age eligibility criteria, which often exclude adolescents and younger AYAs; and limited awareness among treating physicians regarding available clinical trials [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The inclusion of adolescents in clinical trials is crucial for improving both care and survival in this patient group. Therefore, continued investigation into the factors contributing to the underrepresentation of this group, as well as efforts to enhance their recruitment and participation, is essential [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, it has been demonstrated that the use of pediatric treatment regimens in adolescents and younger AYAs leads to improved survival outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Notably, in the studied sample, the group treated with adult protocols achieved a significantly higher event-free survival. This finding may be explained by the fact that the patients treated with adult protocols had more favorable prognostic factors, including localized tumors and histological subtypes associated with better outcomes, potentially acting as a confounding factor.\u003c/p\u003e \u003cp\u003eThe overall five-year EFS rate in this cohort was 73%. This rate is lower than that reported in other epidemiological studies in AYAs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Several factors may contribute to this difference, including the fact that the comparison studies were multicenter, international observational studies with significantly larger sample sizes, longer follow-up periods, and consequently, reduced risk of bias. Furthermore, the development of AYA units in Spain is relatively recent in comparison with other European countries and the United States. Additionally, poorer survival outcomes in our cohort may be associated with the fact that 15% of patients were already in relapse at the time of admission, 6.4% were undergoing second-line treatment, and 5.5% were on third-line therapy or beyond. There was also a higher proportion of patients with bone and soft tissue sarcomas, considering that these tumors are associated with low survival rates [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moreover, 58% of the patients were referred from outside the Gregorio Mara\u0026ntilde;\u0026oacute;n area, often after failing initial therapy, thus presenting with more advanced or refractory disease.\u003c/p\u003e \u003cp\u003eA key issue for cancer survivors of reproductive age is fertility preservation. This should be a priority within AYA-specific programs and services [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In the present review, the proportion of patients who underwent fertility preservation procedures was low compared to the literature [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Efforts should be made to improve this percentage, ensuring that, whenever the patient\u0026rsquo;s clinical status allows, age- and culturally appropriate information is provided to patients and their families.\u003c/p\u003e \u003cp\u003eA significant proportion of AYA cancer patients harbor germline mutations, which are important for prognosis, treatment decisions, risk of second malignancies, and family counseling [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our sample, NGS panel testing was performed in 66% of patients, revealing pathogenic or likely pathogenic mutations in 10% and variants of uncertain significance in 1.4%, consistent with data reported in the literature [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In conclusion, the Gregorio Mara\u0026ntilde;\u0026oacute;n Unit provides multidisciplinary care that addresses the specific needs of adolescents with cancer, offering age-appropriate educational and psychosocial support, as well as collaboration with medical oncology, thereby addressing concerns related to the management of these patients and the survival gap observed when compared to pediatric populations.\u003c/p\u003e \u003cp\u003eThere is a pressing need to address modifiable factors that impact survival, such as increasing participation in clinical trials, optimizing the use of genomic diagnostic tools to enhance tumor characterization in this population, and ensuring the implementation of long-term follow-up programs to reduce morbidity among adolescent cancer survivors.\u003c/p\u003e \u003cp\u003eMulticenter studies involving the various specialized units across the Community of Madrid and nationally are essential. Improved diagnostic reporting in this age group is key to better understanding the current situation of adolescent patients in Spain and to identifying areas for improvement. In this regard, the creation of a unified national registry would allow for earlier implementation of improvements and greater insight into cancer in adolescents.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e-AYA: Adolescents and Young Adults\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e-CNS: Central nervous system\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e-EFS: event-free survival EFS\u003c/p\u003e\n\u003cp\u003e-GIST: Gastrointestinal Stromal Tumor\u003c/p\u003e\n\u003cp\u003e-IOR:\u0026nbsp;intraoperative radiotherapy\u003c/p\u003e\n\u003cp\u003e-NGS: Next Generation Sequencing\u003c/p\u003e\n\u003cp\u003e-OS: Overall survival\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e-SEHOP: Spanish Society of Pediatric Hematology and Oncology\u003c/p\u003e\n\u003cp\u003e-STS: Soft Tissue Sarcoma\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSTATEMENTS AND DECLARATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests, financial or non-financial, related to the content of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection by Belén Huguet and Carmen Garrrido, analysis were performed by Pablo Gónzalez and Perceval Vellosillo. The first draft of the manuscript was written by Belén Huguet and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL CONSIDERATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the legislation, following Organic Law 3/2018 on Personal Data Protection and Guarantee of Digital Rights, as well as Regulation (EU) 2016/679 of the European Parliament and Council of April 27, 2016, on Data Protection (GDPR). It also adhered to the basic principles of bioethics established in the Belmont and Helsinki Declarations. The study was reviewed and approved by the Research Ethics Committee (Comité de Ética de la investigación con medicamentos Hospital General Universitario Gregorio Marañón).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTrama A, Stark D, Bozovic-Spasojevic I, Gaspar N, Peccatori F, Toss A et al (2023) Cancer burden in adolescents and young adults in Europe. ESMO Open 8(1):100744. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.esmoop.2022.100744\u003c/span\u003e\u003cspan address=\"10.1016/j.esmoop.2022.100744\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrari A, Stark D, Peccatori FA, Fern L, Laurence V (2021) Adolescents and young adults (AYA) with cancer: a position paper from the AYA Working Group of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). ESMO Open 6(2):100096\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanssen SH, Vlooswijk C, Manten-Horst E, Sleeman SH, Bijlsma RM, Kaal SE et al (2023) Learning from long‐term adolescent and Young Adult (AYA) cancer survivors regarding their age‐specific care needs to improve current AYA care programs. 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PMID: 33484663\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eN=111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSEX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e57%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMean(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e14.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e(2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e(13.00, 16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10.00,22.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eEXTENT OF DISEASE AT DIAGNOSIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eLocalized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eMetastasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eNot assesable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCLINICAL STATUS AT DIAGNOSIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eDe novo diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e83%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eRelapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eUnder follow up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Epidemiological characteristics of the studied sample. Data are presented as absolute frequencies and percentages for qualitative variables. Quantitative variables are described using the median and interquartile range, as well as the mean and standard deviation.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eLINE OF TREATMENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eFirst\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e88%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSecond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e6.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e5.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePROTOCOL TYPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePediatric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e85 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAdult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNo established protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eHEMATOPOIETIC STEM CELL TRANSPLANTATION\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eTARGETED THERAPY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eRADIOTHERAPY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eTYPE OF RADIOTHERAPY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePhotons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e71%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eProtons\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eI.O.R (Intraoperative Radiotherapy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCLINICAL STATUS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eRemission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eDisease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e8.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCAUSE OF DEATH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eDisease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eToxicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e5.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Treatments Used and Status After Treatment\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"adolescents, AYA, survival, oncology, epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-6767305/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6767305/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eINTRODUCTION: Over the past few years, there has been growing concern about the treatment and management of adolescents and young adults (AYA) with cancer, due to the unique characteristics of these patients transitioning to adulthood and the lack of progress in improving survival compared to younger patients. The main objective of the study is to analyze the epidemiology and overall survival of the adolescent patient cohort at Gregorio Mara\u0026ntilde;\u0026oacute;n Hospital since the creation of the Adolescent Unit.\u003c/p\u003e \u003cp\u003eRESULTS AND DISCUSSION: A study was conducted in the Adolescent Unit of the Gregorio Mara\u0026ntilde;\u0026oacute;n Hospital, analyzing epidemiology and survival. A total of 111 patients were included, with a wide variety of diagnoses, with lymphomas being the most frequent pathology. The 5-year survival rate was 73%. Pediatric treatment protocols were used in 77% of the patients, and fertility preservation techniques were performed in 25% of the cases.\u003c/p\u003e \u003cp\u003eCONCLUSIONS: The Adolescent Unit undertakes a multidisciplinary approach to adolescents and it is necessary to improve the factors that allow an increase in survival and quality of life.\u003c/p\u003e","manuscriptTitle":"Experience in the Approach to Adolescents with Cancer in a Multidisciplinary Unit. Growing Together","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 09:00:10","doi":"10.21203/rs.3.rs-6767305/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-30T18:21:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T23:45:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T16:18:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55757286529685734066892596687402371045","date":"2025-10-01T22:05:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213716593583921151162964798168568929678","date":"2025-09-26T13:29:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148796054305880412643499669910690872832","date":"2025-08-06T10:13:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329808896584613449622034934784968475650","date":"2025-07-11T21:19:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-15T15:33:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-14T11:50:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-14T11:05:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2025-05-28T10:39:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a8a7fdfd-fa99-4021-b965-0ec7841e32e3","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:02:51+00:00","versionOfRecord":{"articleIdentity":"rs-6767305","link":"https://doi.org/10.1007/s00431-026-06747-3","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2026-01-19 15:57:12","publishedOnDateReadable":"January 19th, 2026"},"versionCreatedAt":"2025-06-18 09:00:10","video":"","vorDoi":"10.1007/s00431-026-06747-3","vorDoiUrl":"https://doi.org/10.1007/s00431-026-06747-3","workflowStages":[]},"version":"v1","identity":"rs-6767305","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6767305","identity":"rs-6767305","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}