This case study aims to facilitate the development of competencies that reflect the role of the Specialist Cancer Nurse (SCN) in delivery of supportive care, including provision of information and education for people affected by osteosarcoma in adolescents and young adults (AYA).
Adolescents and young adults (AYA) are a discrete population with unique biological, emotional and social characteristics. A cancer diagnosis is a significant disruption to the major developmental changes that occur across these ages. Peak incidence of osteosarcoma occurs in the AYA group.8 The median age at diagnosis with osteosarcoma is 20 years.6
There are many points along the cancer journey when the SCN can improve outcomes for AYA affected by osteosarcoma. These include:
Section 1: Find the condition early
Symptoms of osteosarcoma may be confused with growing pains.6 Treatment delays of six months or more have been reported among AYA due to late presentation to health services and initial failure to recognise symptoms as indicative of cancer.9
Increasing the awareness of clues to early cancer diagnosis, in the context of normal AYA development within the health care community, may lead to further investigation and earlier referrals to specialist cancer services.2
Section 2: Have the best treatment and support during active treatment
AYA with cancer face unique issues associated with privacy, information sharing, sexuality, fertility, education, employment, peer and family relationships and body image.4, 10, 11
Age-appropriate clinical management strategies should be used to support AYA. Key aspects of care which should be addressed include:4
- maintaining continuity of care
- managing adherence issues
- use of complementary and alternative therapies
- ensuring appropriate boundaries between health professionals and AYA.
Supportive measures for family and significant others are critical to minimise emotional impact and ensure a supportive environment for the AYA with cancer.
Therapeutic relationships with the SCN can facilitate AYA engagement in decision making and treatment.
Section 3: Have the best treatment and support between and after active treatment
AYA who have received treatment for cancer can experience a range of late effects.
AYA may face a transition between paediatric and adolescent services to mainstream adult services in the follow up phases of their cancer journey that can lead to gaps in care. It is important to maintain contact with the young person into survivorship.4
Section 4: Have the best care at the end of life
The transition for the AYA from curative to palliative care can be challenging for all involved.
Provision of age-appropriate palliative care services must focus on the needs and wishes of the young person, support for family and friends and support of health professionals caring for this group.
Early introduction of services is important so young people have the time to build a trusting relationship with palliative care teams, both hospital and community based.4 The SCN can facilitate open and honest exploration of issues, such as spirituality, meaning and personal goals, while providing optimal symptom control.