Response to Barr re: “Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group”

Response to Letter to Editor-in-Chief

We would like to collectively respond to Dr. Ronald Barr's letter to the editor regarding our article. ¹ We wholeheartedly agree with Dr. Barr and recognize that the burden of adolescent and young adult (AYA) cancer is disproportionately borne by low- and middle-income countries. ² Our goal in developing the blueprint was to outline what components of care should be accessible broadly to AYAs with cancer. Although this blueprint was developed within the framework of the United States health care system, we pose that the global cancer community aims to address these gaps more holistically and globally, incorporating additional contextual considerations for other countries' health care systems, whether they be strengths or weaknesses compared with the United States.

Specifically, we acknowledge the “diagnostic deficit” and highlight that improving access to care to reduce delays in diagnosis and increase the speed at which treatment is initiated, is critical to addressing this deficit. As seen in the United States, efforts are needed to improve diagnostic work-ups, utilize remote or technology-based care where appropriate, and increase availability of oncology clinicians ³ to facilitate care delivery. Clearly these challenges are amplified and more difficult to overcome in nations with fewer resources available to dedicate to health care. Improving care and outcomes for AYAs across the globe will require international collaboration and resources to develop and implement novel multilevel approaches to address severe limitations in AYA access to cancer care.