Commentary to "policy and practice in teenage and young adult cancer care in England: looking to the future".

Pearce (2009) considers developments in cancer services for teenagers and young adults (TYA) in England within the context of health services policy, most particularly the National Institute of Health and Clinical Excellence (NICE) Improving Outcomes Guidance for Children and Young People (NICE, 2005). In providing an overview of important aspects of epidemiology of cancer in this patient group and the evidence base and published expert opinion related to some of the key components of services and clinical practice, many of the areas of need, progress and the challenges ahead are highlighted. The focus of NICE cancer service guidance is to advise on the commissioning of services and is therefore different from clinical practice guidelines. The Children and Young People’s Improving Outcomes Guidance recommendations focus on the planning, commissioning and organisation of those aspects of services that are likely to significantly impact upon outcomes. However, the transformations required to deliver IOG-compliant services for young people require a significant response from practitioners as providers of services, to change established clinical practices and develop new approaches to delivering care and support in hospital and community settings. It is important to view delivery of ongoing improvements in cancer services for young people within the broad context of both health services policy and cancer policy. Services and practice related to young people with malignancy cannot be delivered in isolation from overall healthcare policy and cancer strategy, or without regard to developments in the provision of children and young people’s health care generally. Particularly in relation to young adults, the delivery structures and processes of adult cancer services need to be reflected in collaborative TYA service models to provide both disease-specific expertise and age-appropriate cancer care. The National Service Framework (NSF) for children, young people and maternity services (Department of Health, 2004) established national standards for services for children and young people (CYP). Although it specifically relates to young people before their 19th birthday, the NSF was enshrined within the