Quotes of the Day

David supple is doing great - for someone who's spent the past three years fighting for his life.

Last week the Sydney 18-year-old kicked on after his school formal, not creasing his sheets till dawn. The weight and hair he lost as a result of treatment have returned. All being well, he'll start driving and a hospitality course in the New Year, and it won't be long before he's playing sport as exuberantly as he was until, at 15, he noticed a lump on his right arm that turned out to be a symptom of Hodgkin's disease, a cancer of the lymphatic system. Treatment cured him and he was briefly healthy again, but early last year he was diagnosed with acute lymphoblastic leukemia (all), a cancer of the blood and bone marrow that kills more than half of its adolescent and young adult victims.

Given those statistics, Supple - whose chemotherapy winds up in March - is lucky to be alive. Given his age, he's even luckier. While there have been huge strides in treating young children - about 80% of under-15s diagnosed with cancer in Australia and New Zealand will beat the disease, more than double the rate in the 1970s - adolescents and young adults aren't doing nearly as well: depending on the type of cancer, their cure rates are lagging as much as 30 percentage points behind. The figures for all - the most common childhood cancer - illustrate the point. Some 80% of child all patients will be cured; but the same disease will be beaten in only about 40% of cases involving 15- to 25-year-olds. Says Dr. Catherine Cole, a cancer specialist at Princess Margaret Hospital for Children in Perth: "We desperately need to learn more about how to treat (adolescents) effectively."

Experts like Cole believe they know the reasons for the discrepancy. First, it's probable that the same cancer is more aggressive in older children; this needs more research. Second, compared with young children, teens are obstreperous patients. "There could be a compliance component, but it can't just be that they (sometimes) don't take their tablets," says Supple's oncologist, Glenn Marshall, of Sydney Children's Hospital, Randwick. Both doctors think the main explanation for the divergence is that a much higher proportion of child cancer patients take part in clinical trials. "In child cancer medicine, trials have been the bedrock on which cure rates have gone up," says Marshall, adding that adolescents haven't had the same access to trials. The unspoken conclusion is that many young people have died needlessly as a result.

In Australia, most young children with cancer are treated in pediatric hospitals (invariably teaching hospitals linked to a university) and most of these kids are enrolled in trials. The idea of trials as bold experiments with mysterious drugs is wrong. Often there's no new agent involved. Oncologists have been treating all with the same eight drugs for more than 20 years; the improved cure rate among children results from new combinations and dosages proven in trials to work. Supple is part of a five-year trial involving infants and children under 17, in which most participants receive standard best treatment while those at greatest risk of relapse receive more aggressive treatment.

Just under 1,000 12- to 24-year-olds are diagnosed with cancer in Australia each year. Most pediatric oncologists would argue that these patients, if theirs is a cancer type common among children (certain leukemias, and bone and soft tissue tumors) would be best treated in a children's hospital. But governments bar such hospitals from treating new patients above a certain age, usually 17. So teenage cancer patients are scattered through the health system, many being seen by oncologists more used to treating the cancers of middle and old age. These doctors, argue their pediatric counterparts, tend to back off on dosages too quickly, not appreciating how much more resilient younger people are. "Pediatric doctors are used to causing side effects and illness," says Marshall. "We accept that, because we know that there's a cure at the end."

Nonetheless, getting patients to submit to the onslaught is hard. More than most cancer patients, adolescents dwell in the "Why me?" phase and resist treatment that robs them of looks and vitality. Supple's mother Jenny says he threatened "all the time" to stop taking his medicine and could go for days without speaking. During his numerous hospital stays, his Mum or Dad was always with him, but nurses and psychologists also helped - a coordinated support staff typical of pediatric hospitals. Andrew Young, chief executive officer of CanTeen, a support organization for young people with cancer, echoes the calls of pediatric oncologists for centers or hospital wings dedicated to adolescent patients - there are eight such places in Britain, where authorities say it's too early to speculate on their impact on cure rates. To improve adolescents' chances, says Cole, "We need to understand what stops them participating in trials, help teenagers stick to treatment and develop more trials which target specific tumors in this age group. From doctors, hospitals and government ministers, we need a new philosophy of thinking." Then, perhaps, success stories like Supple's will be the rule, not the exception.

• Daniel Williams
• Cancer Kids’ Catch-17