Each year, nearly 70,000 adolescents and young adults (AYA) are diagnosed with cancer. Lymphoma is the most common type of blood cancer and accounts for nearly 1-in-5 cancer diagnoses among young people.
Survivors of cancers that occurred during adolescence and young adulthood (AYA) are confronted with the dual demands of managing their transition to independent adulthood, concurrently with their transition from cancer patient to cancer survivors.
Kristie A. Blum, MD, discusses the management of adolescents and young adults with cancer and the special challenges these brave young patients face.
Management of Adolescents and Young Adults with Cancer
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Learn more about Kristie A. Blum, MD
Kristie A. Blum, MD
Kristie A. Blum, MD, is Acting Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. A board certified hematologist, Dr. Blum has extensive experience in the clinical development of novel therapeutics for patients with aggressive B-cell non-Hodgkin's lymphoma and Hodgkin's lymphoma. Prior to joining Emory in 2017, Dr. Blum was Professor in the Divison of Hematology in the Department of Internal Medicine at The Ohio State University - James Cancer Hospital and Solove Research Institute where she was also the Director of the Lymphoma Clinical Research Program.Learn more about Kristie A. Blum, MD
Transcription:
Bill Klaproth (Host): Welcome to Emory Healthcare Rounds. I’m Bill Klaproth. Today’s topic is management of adolescents and young adults with cancer. Our guest is Dr. Kristie Blum, Acting Professor, Department of Hematology and Medical Oncology at Emory University School of Medicine. Dr. Blum, thanks for your time. So, what is the most common cancer in teenagers?
Kristie A. Blum, MD (Guest): Yeah, so, I think just for clarification purposes, I just wanted to kind of mention that the National Cancer Institute sort of identifies people as age 15 to 39 as the definition for young adults with cancer. So, it actually spans a pretty broad range of patients. But in that group, the most common cancers are lymphomas, both Hodgkin’s and Non-Hodgkin’s lymphomas and then other cancers like testicular cancer, melanoma, thyroid cancer, ovarian and breast cancers can also be seen, and we also do see a higher risk of sarcomas and leukemias in that same age group.
Host: So, is there a reason that lymphoma especially strikes this group of young adults?
Dr. Blum: Yeah, a good question. I don’t think anybody really knows the answer to that, but both lymphomas and then something we call ALL or adult lymphocytic leukemia can also be seen pretty commonly in this group. And they affect – the lymphomas affect about 20% of this population, but things like testicular cancer and melanoma are in 11 or 12% of these patients too, so they are just as frequent.
Host: So, what are the signs then that a young adult may have cancer?
Dr. Blum: Yeah, this really depends on what kind of cancer it is. And it can range from anything to feeling a new lump or having a new site of pain that’s just not going away, sometimes fatigue, sometimes just abnormal blood counts. So, really, it’s important for patients even in this sort of young adult group to get their annual physicals and checkups with their primary care physician.
Host: This is such a difficult time Dr. Blum. How does Winship help young adults navigate cancer care?
Dr. Blum: Yeah, so, Winship and a number of other hospitals across the country have really made an effort to start to develop what we call AYA or adolescent cancer programs and this is important because these patients kind of fall in that age group where they are leaving their pediatricians, perhaps moving on to adult physicians and so, they can often kind of get lost in that transition. So, the nice thing about a lot of these AYA cancer programs including what’s being developed here at Winship; is that they have collaborations kind of ongoing between pediatricians and adult physicians, oncologists, radiation doctors. They also have a lot of specialists including fertility specialists that are important in cancer care in this group as well as navigators and support groups and things like that available to these patients.
And then ultimately, the goal of some of these groups is really to increase research in this area too because again, a lot of these patients miss the opportunity for clinical trials and research that were normally geared to either pediatric patients or adult patients. And so, really doing research in this group is important as well so that we can develop new treatments for them.
Host: I could see that and I’m just thinking about lymphoma. What is the success rate of treating lymphoma? Are most of those patients with cancer, are they able to be cured or be put into remission where they are able to manage it then, throughout their life? How does that work?
Dr. Blum: Yeah, absolutely. So, the big thing about lymphoma of course, is there are a number of different types and the most common one in adolescence is something that we call Hodgkin’s lymphoma. And even in that, there are a couple of different subtypes. But for the most common Hodgkin’s lymphomas, close to 85-90% of patients are cured and are able to kind of continue to have a normal life and normal expectations for their life after the treatment is all done.
Host: Now earlier you said the age range of young adults with cancer is 15-39. That means women of childbearing years are affected by this. So, what fertility issues come up with young patients and cancer care?
Dr. Blum: Yeah, so, I think the most common issue is really looking at fertility preservation and it really depends a lot on what the cancer is, what the planned treatment is. So, for example, in Hodgkin’s, some of our very standard first line treatments, so when you are first diagnosed actually don’t have a big impact on fertility so, we have less concerns about it. But other treatments that we may offer for example, if the cancer came back, may actually cause sterility long-term and so, it’s an important thing to kind of get involved with a reproductive endocrinologist very early for both kind of men and women and look at observations for egg preservation, for men would be sperm banking in those situations so that those things can be discussed and then opportunities to really preserve fertility long-term after their treatments are all done. And again, really one of the focuses of some of these AYA cancer programs is to kind of loop in those fertility specialists very early on in a patient’s care.
Host: And Dr. Blum, earlier you were talking about support. What types of emotional support are extended to young adult cancer patients?
Dr. Blum: Sure, there are a lot of different options out there. A lot of programs have navigators and just as you can imagine again, figuring out where to go in a complex health system, whether you are starting in a pediatric setting and then moving to an adult system can be very challenging. So, a lot of these cancer programs will offer navigators that sort of help do that. A lot of them have also started to develop support groups where young cancer patients can meet other cancer patients because sometimes they feel very isolated when they come to a cancer waiting room and they see a lot of older adults for example or they see if they are in a pediatric waiting room a lot of young children whose needs are a lot different than theirs. So, a lot of these support groups are available where they can meet people their own age and kind of talk about their experiences. There are counseling services available and then there’s a lot of national groups that are really working to help network with these patients and also help again, put them in contact with other patients across the country. So, the Lymphoma Research Foundation is one group that I work with that really specializes in young adults with lymphomas, but there’s the Live Strong Foundation as well and then Teen Cancer America which are all good groups for these patients to look into.
Host: Well speaking of pediatric cancer patients got me thinking. When should a childhood cancer patient transition from a pediatric oncologist to another provider?
Dr. Blum: A very good question, I think one we don’t have great answers to. I would really encourage the patient to talk first to their pediatrician about when is the best time to do this. A lot of times again, at Winship for example, we have very close connections with our pediatric hospital so many of their physicians and I’m an adult oncologist, will actually reach out to me and say we have this patient, we have treated them, we want to know what kind of options you have and so we have sort of a close network where we can communicate and really discuss when is the best time for that transition. But I think the best thing for a patient is really just talk about that first with their pediatrician. And on the same note, occasionally an 18-year-old may end up in an adult oncology clinic and we do know for things like sarcomas and leukemias, sometimes for the younger patients following more of a pediatric treatment protocol is better in terms of their outcome. So, on the flip side, somebody who ends up in an adult oncology clinic, who is right in that age range should actually ask, is there something on the pediatric side that maybe I should look into. So, really, having that discussion with your oncologist whether it’s on the peds or the adult side I think is important.
Host: And Dr. Blum let me ask you this. Is cancer in young adults generally hereditary? Because I’m thinking they are too young to have poor lifestyle choices impact their health at this point, is that correct?
Dr. Blum: It actually isn’t clear in a lot of cancers. So, for most lymphomas, we don’t know why patients develop them for example, and they often are not hereditary. You can see some rare hereditary lymphomas so occasionally that will happen. But especially for the majority of the young adult cases, it’s not often a hereditary situation. It really is something that occurs for a reason we don’t know. It may be some sort of environmental exposure, but even for most patients for lymphoma, we don’t really have information on what that might be that patients are exposed to. So, I think it’s an active area of research, but generally is not a hereditary type of situation.
Host: And lastly, Dr. Blum is there anything else we need to know about management of adolescents and young adults with cancer?
Dr. Blum: Again, I think the most important thing is to really think about going to either a major academic center or a nationally recognized comprehensive cancer center if you are in that situation, just because a lot of these places are really going to have these collaborations already set up between the pediatric and the adult groups. They are going to be aware of most of the active research and then also, have some of these new trials with new agents available. So, whether you – even if you don’t start at one of these academic centers, just getting a second opinion there I think is always worthwhile to really make sure you are on the right track for your treatment and then looking at also sort of anticipating long-term complications. I think that’s one thing I didn’t get a chance to touch on is just that ultimately one of the things that faces these patients is 20 years after your treatment, are you going to have any complications as a result of that treatment that need to be watched for and there are things like risks potentially with some chemotherapy drugs and heart disease, there’s also risks for secondary cancers later on. So, learning about those risks as well with some of the treatments and then having an opportunity to really monitor those long-term with your oncologist is important.
Host: Dr. Blum thanks for your time. Winship Cancer Institute of Emory University is an NCI comprehensive cancer center. Should you have questions or wish to discuss the care of your patients please use our referral form or call us at 888-WINSHIP, that’s 888-946-7447. You’re listening to Emory Healthcare Rounds. For more information on Winship Cancer Institute of Emory University please visit www.emoryhealthcare.org/referwinship, that’s www.emoryhealthcare.org/referwinship. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Welcome to Emory Healthcare Rounds. I’m Bill Klaproth. Today’s topic is management of adolescents and young adults with cancer. Our guest is Dr. Kristie Blum, Acting Professor, Department of Hematology and Medical Oncology at Emory University School of Medicine. Dr. Blum, thanks for your time. So, what is the most common cancer in teenagers?
Kristie A. Blum, MD (Guest): Yeah, so, I think just for clarification purposes, I just wanted to kind of mention that the National Cancer Institute sort of identifies people as age 15 to 39 as the definition for young adults with cancer. So, it actually spans a pretty broad range of patients. But in that group, the most common cancers are lymphomas, both Hodgkin’s and Non-Hodgkin’s lymphomas and then other cancers like testicular cancer, melanoma, thyroid cancer, ovarian and breast cancers can also be seen, and we also do see a higher risk of sarcomas and leukemias in that same age group.
Host: So, is there a reason that lymphoma especially strikes this group of young adults?
Dr. Blum: Yeah, a good question. I don’t think anybody really knows the answer to that, but both lymphomas and then something we call ALL or adult lymphocytic leukemia can also be seen pretty commonly in this group. And they affect – the lymphomas affect about 20% of this population, but things like testicular cancer and melanoma are in 11 or 12% of these patients too, so they are just as frequent.
Host: So, what are the signs then that a young adult may have cancer?
Dr. Blum: Yeah, this really depends on what kind of cancer it is. And it can range from anything to feeling a new lump or having a new site of pain that’s just not going away, sometimes fatigue, sometimes just abnormal blood counts. So, really, it’s important for patients even in this sort of young adult group to get their annual physicals and checkups with their primary care physician.
Host: This is such a difficult time Dr. Blum. How does Winship help young adults navigate cancer care?
Dr. Blum: Yeah, so, Winship and a number of other hospitals across the country have really made an effort to start to develop what we call AYA or adolescent cancer programs and this is important because these patients kind of fall in that age group where they are leaving their pediatricians, perhaps moving on to adult physicians and so, they can often kind of get lost in that transition. So, the nice thing about a lot of these AYA cancer programs including what’s being developed here at Winship; is that they have collaborations kind of ongoing between pediatricians and adult physicians, oncologists, radiation doctors. They also have a lot of specialists including fertility specialists that are important in cancer care in this group as well as navigators and support groups and things like that available to these patients.
And then ultimately, the goal of some of these groups is really to increase research in this area too because again, a lot of these patients miss the opportunity for clinical trials and research that were normally geared to either pediatric patients or adult patients. And so, really doing research in this group is important as well so that we can develop new treatments for them.
Host: I could see that and I’m just thinking about lymphoma. What is the success rate of treating lymphoma? Are most of those patients with cancer, are they able to be cured or be put into remission where they are able to manage it then, throughout their life? How does that work?
Dr. Blum: Yeah, absolutely. So, the big thing about lymphoma of course, is there are a number of different types and the most common one in adolescence is something that we call Hodgkin’s lymphoma. And even in that, there are a couple of different subtypes. But for the most common Hodgkin’s lymphomas, close to 85-90% of patients are cured and are able to kind of continue to have a normal life and normal expectations for their life after the treatment is all done.
Host: Now earlier you said the age range of young adults with cancer is 15-39. That means women of childbearing years are affected by this. So, what fertility issues come up with young patients and cancer care?
Dr. Blum: Yeah, so, I think the most common issue is really looking at fertility preservation and it really depends a lot on what the cancer is, what the planned treatment is. So, for example, in Hodgkin’s, some of our very standard first line treatments, so when you are first diagnosed actually don’t have a big impact on fertility so, we have less concerns about it. But other treatments that we may offer for example, if the cancer came back, may actually cause sterility long-term and so, it’s an important thing to kind of get involved with a reproductive endocrinologist very early for both kind of men and women and look at observations for egg preservation, for men would be sperm banking in those situations so that those things can be discussed and then opportunities to really preserve fertility long-term after their treatments are all done. And again, really one of the focuses of some of these AYA cancer programs is to kind of loop in those fertility specialists very early on in a patient’s care.
Host: And Dr. Blum, earlier you were talking about support. What types of emotional support are extended to young adult cancer patients?
Dr. Blum: Sure, there are a lot of different options out there. A lot of programs have navigators and just as you can imagine again, figuring out where to go in a complex health system, whether you are starting in a pediatric setting and then moving to an adult system can be very challenging. So, a lot of these cancer programs will offer navigators that sort of help do that. A lot of them have also started to develop support groups where young cancer patients can meet other cancer patients because sometimes they feel very isolated when they come to a cancer waiting room and they see a lot of older adults for example or they see if they are in a pediatric waiting room a lot of young children whose needs are a lot different than theirs. So, a lot of these support groups are available where they can meet people their own age and kind of talk about their experiences. There are counseling services available and then there’s a lot of national groups that are really working to help network with these patients and also help again, put them in contact with other patients across the country. So, the Lymphoma Research Foundation is one group that I work with that really specializes in young adults with lymphomas, but there’s the Live Strong Foundation as well and then Teen Cancer America which are all good groups for these patients to look into.
Host: Well speaking of pediatric cancer patients got me thinking. When should a childhood cancer patient transition from a pediatric oncologist to another provider?
Dr. Blum: A very good question, I think one we don’t have great answers to. I would really encourage the patient to talk first to their pediatrician about when is the best time to do this. A lot of times again, at Winship for example, we have very close connections with our pediatric hospital so many of their physicians and I’m an adult oncologist, will actually reach out to me and say we have this patient, we have treated them, we want to know what kind of options you have and so we have sort of a close network where we can communicate and really discuss when is the best time for that transition. But I think the best thing for a patient is really just talk about that first with their pediatrician. And on the same note, occasionally an 18-year-old may end up in an adult oncology clinic and we do know for things like sarcomas and leukemias, sometimes for the younger patients following more of a pediatric treatment protocol is better in terms of their outcome. So, on the flip side, somebody who ends up in an adult oncology clinic, who is right in that age range should actually ask, is there something on the pediatric side that maybe I should look into. So, really, having that discussion with your oncologist whether it’s on the peds or the adult side I think is important.
Host: And Dr. Blum let me ask you this. Is cancer in young adults generally hereditary? Because I’m thinking they are too young to have poor lifestyle choices impact their health at this point, is that correct?
Dr. Blum: It actually isn’t clear in a lot of cancers. So, for most lymphomas, we don’t know why patients develop them for example, and they often are not hereditary. You can see some rare hereditary lymphomas so occasionally that will happen. But especially for the majority of the young adult cases, it’s not often a hereditary situation. It really is something that occurs for a reason we don’t know. It may be some sort of environmental exposure, but even for most patients for lymphoma, we don’t really have information on what that might be that patients are exposed to. So, I think it’s an active area of research, but generally is not a hereditary type of situation.
Host: And lastly, Dr. Blum is there anything else we need to know about management of adolescents and young adults with cancer?
Dr. Blum: Again, I think the most important thing is to really think about going to either a major academic center or a nationally recognized comprehensive cancer center if you are in that situation, just because a lot of these places are really going to have these collaborations already set up between the pediatric and the adult groups. They are going to be aware of most of the active research and then also, have some of these new trials with new agents available. So, whether you – even if you don’t start at one of these academic centers, just getting a second opinion there I think is always worthwhile to really make sure you are on the right track for your treatment and then looking at also sort of anticipating long-term complications. I think that’s one thing I didn’t get a chance to touch on is just that ultimately one of the things that faces these patients is 20 years after your treatment, are you going to have any complications as a result of that treatment that need to be watched for and there are things like risks potentially with some chemotherapy drugs and heart disease, there’s also risks for secondary cancers later on. So, learning about those risks as well with some of the treatments and then having an opportunity to really monitor those long-term with your oncologist is important.
Host: Dr. Blum thanks for your time. Winship Cancer Institute of Emory University is an NCI comprehensive cancer center. Should you have questions or wish to discuss the care of your patients please use our referral form or call us at 888-WINSHIP, that’s 888-946-7447. You’re listening to Emory Healthcare Rounds. For more information on Winship Cancer Institute of Emory University please visit www.emoryhealthcare.org/referwinship, that’s www.emoryhealthcare.org/referwinship. I’m Bill Klaproth. Thanks for listening.