Adam DuVall, MD, MPH, is a rare medical oncologist who trained in both adult and pediatric hematology\/oncology.<\/p>\n This distinction, which DuVall said he shares with only a handful of oncologists in the world, matches his role at University of Chicago (UChicago) Medicine, Chicago. Since joining UChicago in 2020, DuVall has helped expand its Adolescent and Young Adult (AYA) Oncology Program<\/a>, which aims to provide comprehensive, one-stop care and support for patients with cancer aged from 15 to 39 years.<\/p>\n Started in 2012, the program is one of the oldest in a growing array of initiatives nationwide that seek to address the specific psychosocial and other support needs of patients with cancer who fall into the gap between young children and the older patients who more typically have cancer. Along with DuVall and other oncologists, UChicago\u2019s AYA Program offers dedicated nurse practitioners, social workers, psychologists, a physical therapist, and a program administrator. A community health worker, who does home visits, helps patients coordinate travel, works with their insurance, and generally navigates the medical system, DuVall added.<\/p>\n The program receives about 1500-2000 visits a year, according to DuVall. What the young adult population with cancer has in common that distinguishes it from other age cohorts, he said, are its members\u2019 particular psychosocial needs. \u201cGoing through adolescence and young adulthood without cancer, there\u2019s plenty of things that are hard,\u201d DuVall observed. \u201cPut cancer on top of that, and it impacts every aspect of life.\u201d<\/p>\n The proliferation of AYA programs comes as more and more studies have been published recently showing that young adults are increasingly getting cancer.<\/p>\n According to American Cancer Society research<\/a> published in December in The Lancet Oncology<\/em>, incidence rates of colorectal cancer (CRC) among young adults aged 25-49 years rose in the decade through 2017 in more than half of the 50 countries and territories examined. For the past 5 years studied, the incidence rate of early-onset CRC was highest in Australia, Puerto Rico, New Zealand, the United States, and South Korea. At the same time, the study found, rates among older adults in all of those places except South Korea were stable or declining.<\/p>\n Hyuna Sung, PhD, the study\u2019s lead author, said, \u201cResearch has shown that Gen X and millennials have higher risk of multiple types of cancer compared to the older generations.\u201d<\/p>\n Some of the cancers found to be increasing among younger adults are linked to \u201cexcess body obesity,\u201d Sung said, including not only CRC but also cancers of the uterine corpus, gallbladder, kidney, pancreas, breast, and stomach cardia, as well as myeloma. Early onset of cancers not linked to obesity, such as testicular cancer and small intestinal cancer, has also been shown to be on the rise, Sung noted.<\/p>\n As cancer rates among young adults have risen, nonprofits have stepped in to help medical institutions open programs geared to their needs. Teen Cancer America, founded by members of rock band The Who, has partnered with 64 hospitals in 36 cities to develop AYA-focused programs, funding 85 hospital positions, according to a spokesperson. The Los Angeles\u2013based nonprofit has also provided free consultation to 130 hospitals without formally providing a grant, the spokesperson said.<\/p>\n A map<\/a> on Teen Cancer America\u2019s website illustrates the nationwide spread of AYA programs, from UCLA Santa Monica Medical Center to Memorial Sloan Kettering Cancer Center in New York City, with more in between.<\/p>\n Michael Roth, MD, co-director of the AYA Program<\/a> at the University of Texas MD Anderson Cancer Center in Houston, likes to say, \u201cIf you\u2019ve seen one AYA Program, you\u2019ve seen one AYA Program.\u201d<\/p>\n In other words, offerings vary. \u201cMost centers do not have comprehensive AYA programs,\u201d Roth said, noting that at many sites the AYA Program might consist of oncofertility support. \u201cThat said, programs are doing the best they can, knowing that the AYA population is growing exponentially globally.\u201d<\/p>\n Almost 90,000 AYA patients are diagnosed with cancer each year, and 85% will be at least 5-year survivors, Roth said. There are more than 2 million survivors of AYA cancer, he added, and if the median age of diagnosis is 30, they can live five decades beyond their cancer treatment. \u201cTheir life matters,\u201d Roth said. \u201cIt matters during treatment. Their life after cancer matters.\u201d<\/p>\n The AYA Program at MD Anderson began in 2017, and it sees more than 2000 AYAs diagnosed with cancer every year, according to Roth. The program is designed to complement the care that patients with cancer aged from 15 to 39 years or older may already be receiving from their primary treatment teams. New patients see a medical provider, a social worker, and a vocational counselor for discussions about their needs and concerns, and they have access to a nutritionist and genetic counselor.<\/p>\n The program offers psychosocial and supportive care for patients who may be facing challenges with school, work, relationships, having young children, and mental health, Roth said. Along with assessments and counseling around fertility risks and genetic predisposition, MD Anderson also provides patients in the program with a long-term survivorship plan.<\/p>\n \u201cIt\u2019s not just increasing cures,\u201d Roth observed. \u201cWe\u2019re also setting them up for a life of meaning and happiness and productivity and health.\u201d<\/p>\n Almost 40% of visits to the program are conducted virtually, according to Roth. \u201cOur goal is to meet the patients where they are,\u201d he said. \u201cWe want to be convenient, not be a burden.\u201d<\/p>\n Patients with AYA cancer diagnoses may be finishing up school or starting a job, developing their body image and sexual identity, or caring for young children or older parents.<\/p>\n \u201cThey feel incredibly isolated,\u201d said Ann LaCasce, MD, MMSc, co-director of the Center for Adolescent and Young Adult Oncology at Dana-Farber Cancer Institute in Boston. \u201cThey go into the cancer center or their community practice, and everyone is double, triple their age.\u201d<\/p>\n Last year, Dana-Farber opened a Young Adult Lounge<\/a> meant for patients aged 18 years or older to be able to relax and, if they wish, interact between appointments. \u201cWhen you talk to these patients, they want to meet each other,\u201d LaCasce said. \u201cThey want to share experiences.\u201d<\/p>\n The Young Adults With Cancer Program<\/a> at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, opened its doors in 2019. It recently hired an interim nurse navigator, said Cathy Eng, MD, FACP, FASCO, director of the Program, which concentrates on patients aged 25-45 years.<\/p>\n \u201cThe face of cancer has changed,\u201d Eng said.<\/p>\n She advises other oncologists to talk to their young adult patients as much as possible. \u201cReally talk to them as an individual and see what other needs they have,\u201d she said. \u201cEven if they don\u2019t tell you the first time, ask them the second time, ask them the third time.\u201d<\/p>\n Christopher Cann, MD, executive director of the Young Adult Cancer Program<\/a> at Fox Chase Cancer Center in Philadelphia, did his fellowship under Eng. He joined Fox Chase in 2023, and the Young Adult Cancer Program started accepting patients around the end of last year, zeroing in on patients aged 18-39 years.<\/p>\n Following the implementation of a new best practice advisory that pops up in the medical records system, he said, oncofertility referrals increased by 400% within 6 months.<\/p>\n \u201cMy hope is that if every institution throughout the country can have a young adult program, even something small like this can provide a large impact for patients,\u201d Cann said.<\/p>\n The University of North Carolina (UNC) AYA Cancer Program<\/a>, part of the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, formed in 2015. It has expanded into a team of about 12 including a nurse practitioner, fertility counselor, and psychologist, said Jacob Stein, MD, MPH, the program\u2019s AYA oncology liaison. UNC sees about 400 AYA patients with cancer annually, and the program interacts with slightly more than 100 of them, according to Stein.<\/p>\n \u201cOur program has taken a very different approach, to target services, contact, and engagement with AYAs who we perceive to be at the highest need, either clinically or socially, for support,\u201d he said.<\/p>\n Stein was the lead author on research<\/a> presented last year at the ASCO Quality Care Symposium in San Francisco finding that patients engaged in the program were more likely to participate in clinical trials and received higher rates of fertility preservation and palliative care than AYA patients at UNC without program contact.<\/p>\n Andrew Smitherman, MD, MS, medical director of the UNC AYA Cancer Center Program, said the AYA field has grown impressively since a progress review group<\/a> was started in 2005, which was backed by the National Cancer Institute and LIVESTRONG Young Adult Alliance. The group developed recommendations to address AYA oncology nationwide, in hopes of acting as a catalyst for future initiatives. Clearly, others caring for patients with cancer heard the message.<\/p>\n \u201cIf a colleague comes to me and says, \u2018Where do I start, how do I make this change at my institution,\u2019 I usually lead with changing the culture,\u201d Smitherman said. \u201cEducating hospital leadership about the importance of this population, educating colleagues, finding partners. And then start thinking about ways to make structural changes, like creating space. That\u2019s worked really well for us.\u201d<\/p>\n![\"Business](\"https:\/\/img.medscapestatic.com\/vim\/live\/professional_assets\/medscape\/images\/thumbnail_library\/ht_250411_duvall_adam_120x156.jpg\" "This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.")
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