Table 1.
Cultural Context for Introducing Advance Care Planning for Adolescents and Young Adults
| Brazil | Australia | |
|---|---|---|
| Population | 190 million | 23. 4 million |
| Race/Ethnicity* | White (47.7%) Multiracial, (43.1%) Black (7.6%) Asian (1.1%) Indigenous (0.4%) |
English (25%) Australian (23.3%) Irish (7.6%) Scottish (6.4%) Chinese (3.9%) Aboriginal/Torres Strait Islander (2.8%) |
| Religion | Catholic (64.6%) Evangelical (22%) Other religions (5%) No religion (8%) |
No religion (30.1%) Catholic (22.6%) Anglican (13.3%) Uniting Church (3.7%) Islam (2.6%) Buddhism (2.4%) |
| Overall cancer diagnoses in AYA** | 236.16 cases per million (Brazil, 2016) | 419 cases per million (AIHW, 2011) |
| Cancer survival in AYA | 65%*** | 88%**** |
| Decision-making | Family-level discussions/consultations in both pediatric and adult treatment settings | Family-level discussions/ consultations in pediatric***** treatment settings, individual patient consultations (typically together with a partner/support person/caregiver) in adult treatment settings |
| Models of Care | Multidisciplinary approach; Transition from
paternalist to shared-decision making model |
Multidisciplinary approach; Shared-decision making model |
Notes. The statistic refers to the reported race/ethnicity, in Brazil (Brazil, 2012) and to the reported ancestry, in Australia (Australian Bureau of Statistics, 2017).
Age-standardized rate, for AYAs aged 15–29 years old.
Estimate survival for all cancers in AYAs aged 15–29 years old (Brazil, 2016).
5-year relative survival. This high survival rate is in part due to the prevalence of melanoma, which is the most prevalent cancer diagnosis among Australian AYAs, and has a 96% 5-year relative survival rate in Australia. A number of other cancers continue to experience poorer survival rates in Australia including central nervous system cancers (e.g., glioblastoma, anaplastic astrocytoma: 5-year relative survival rates of 41%) and rhabdomyosarcoma; 5-year relative survival of 49%).
For a newly diagnosed cancer patient, typically Australian pediatric hospitals cease admitting adolescents after the age of 17 years, though this may differ according to particular institutions’ policies, the type of cancer/presentation the adolescent presents with, and their access to different treatment options at a pediatric versus adult hospital site.