Teenage and Young Adult

The Teenage Cancer Trust awarded the first UK Chair in Teenage and Young Adult Cancer to The University of Manchester, The Christie NHS Foundation Trust and Central Manchester and Manchester Children's University Hospitals Trust in 2005. Tim Eden is the first holder of that Chair. The research programme for the Unit consists of an exploration of:

Who gets cancer in this age range, with what incidence and what survival?

This work is collaborative work between Professor Jill Birch, Dr Marco Geraci, Dr Tony Moran,Professor Eden and their research and service teams. We are analysing North West and national data (from the Office of National Statistics) in terms of incidence of cancer in the age range 13 - 24 years, its relationship to basic demographics including social deprivation and correlating that with mortality. (CR UK, NHS, TCT and Clic Sargent funded)

Why do young people get cancer?

The incidence data gives us some clues to the way forward possible aetiology eg the 25% of tumours that we see especially in adolescents include bone and germ cell tumours are occurring at the time of maximum growth and maximum disturbance of the hormonal constitution of the body.

Some of the malignancies in this age (10%) are the tail of childhood cancers and may have similar origins to cancers that we have previously investigated in childhood but the majority of tumours (65%) seen in this age range are early onset adult type cancers. We believe strongly that gene environment interactions are responsible for causation or at least proliferation of pre-malignant clones. The research programme is exploring some of the common germ line gene mutations related to cancer as well indepth exploration of DNA damage recognition and repair pathways most specifically the Fanconi gene pathway. Key collaborators are again Professor Jill Birch, Dr Tony Moran, Tim Eden and for the DNA work Dr Stefan Meyer and Dan White (CR UK funded).

Do patients in this age range delay their presentation or are they delayed by doctors and the healthcare system?

We are exploring the pathway to diagnosis and reasons for the long symptom intervals seen in this age range. This involves work within the North West and also collaboration with Leeds and in a multi-centre study funded by CLIC Sargent led by Dr Faith Gibson from London involving Manchester, Leeds, Southampton and London. Key collaborators are Tim Eden, Sam Smith from Manchester, Sue Morgan and Ian Lewis from Leeds, Faith Gibson from London. Tim Eden has led for the National Cancer Research Institute Teenagers and Young Adult Clinical Studies Development Group on liaison with the Primary care Group of the NCRI to develop strategies to explore GP knowledge gaps and ways in which the recognition of  where symptoms can be improved.

Clinical trials

Data collected by the NCRI Group (Fern and Whelan) demonstrate that there is a fall off in trial entry during the adolescent and young adult life compared with children and we are collectively exploring if this due to lack of trials or lack of entry. If it is lack of entry whether that is patient or physician led.Tim Eden is leading on exploring this issue in lymphoma (Hodgkin's and non Hodgkin's lymphoma) and what can be achieved by closer collaboration between adult and paediatric groupings.

Adherence to therapy

One of the perceived problems in teenagers and young adults is that they don't adhere/comply with treatment. This is the focus of a study funded by the Teenage Cancer Trust led by Tim Eden with Jonathan Hill (Professor of Childhood and Adolescent Psychiatry) and Dr Helena Kondryn using objective and subjective measures of adherence including opinions from patient, patient's named best buddy, primary consultant, primary nurse, and objective measures of blood levels for key supportive drugs. The patient will also complete questionnaires on mental health states, attitude to illness and family relationships. Overall psychosocial support and further research in this area is planned in collaboration with Dr Ann Grinyer of The University of Lancaster.