Doctors may not be giving young cancer patients what they need

Cancer mortality rates in the United States have been steadily declining for decades. However, there are some caveats. Recently, there has been a small but alarming increase in the incidence of certain cancers, particularly colon cancer, among adults under 50 years of age. These patients have a set of needs that require a health care system accustomed to older patient populations. , we don’t always meet.

It starts with timely diagnosis. Many people do not know they have cancer until it is already in the later stages. But young people also need a different kind of help during treatment and to survive.

In 2018, Memorial Sloan Kettering Cancer Center opened the nation’s first clinic for early-onset patients as colorectal cancer cases in people in their 20s, 30s, and 40s are steadily increasing. . Several other large cancer centers have followed suit. While a cancer diagnosis is life-changing at any age, MSKCC oncologists have found that younger patients need a different kind of support.

“We were very careful with their cancer treatment, but [patients] We felt we were missing out on other aspects of their lives,” says Robin Mendelsohn, co-director of the clinic.

Unlike most elderly patients, younger people may be juggling treatment with burgeoning careers, young children, and aging parents. It can cause financial strain. A 2020 Early Onset Patient Survey by the nonprofit Colorectal Cancer Alliance found that more than half of respondents felt financial stress “often” or “always,” and 66% said their illness was a financial problem. They answered that they were worried that it might cause

Some may not have had children yet, but they must face the possibility that a life-saving treatment could take away their ability to reproduce. The CCA study found that a significant proportion of women, 37% of women and 16% of men, are infertile due to cancer treatment. However, only 31% of respondents said their care team discussed fertility preservation. Improving these numbers seems like a low bar that the oncology community can certainly overcome.

But even if this topic is brought up, there is another issue. Not all insurance companies cover fertility preservation. Egg retrieval can cost tens of thousands of dollars. Although several subsidy programs exist to cover or defray this cost, it would be far better for insurance companies to recognize it as a core part of the care of young cancer patients. .

And young patients also need help to survive. The tumor may be gone, but its effects may continue. Surgery for some types of colorectal cancer can affect sexual function. Some patients may experience changes in their appearance or may require a stoma bag, either temporarily or permanently.

Whether you’re hesitant about dating or simply going out to dinner with friends, “all of these things are impacting your social relationships in ways you don’t see,” says Nancy Yu, director of MD Anderson’s Juvenile Colorectal Program. talk.

And the anxiety from the life-threatening experience remains, and for some people, it can even be completely traumatic. Age-appropriate support networks, where survivors feel understood by people at similar life stages, can help overcome these challenges. But young cancer patients say it’s often difficult to find such groups.

Not all hospitals have the resources to provide young patients with the multidisciplinary teams needed to address these physical, mental, and financial challenges. For under-resourced or rural hospitals, telehealth referrals can play an important role in supplementing in-person care.

Another thing that younger patients need is better data. Much of the medical knowledge about the long-term effects of colon cancer treatment, such as the heart damage associated with common chemotherapy treatments, comes from the use of the drugs in older patient populations. But if people receive the same treatments in their 20s and 30s, what impact will this have on their health when they are in their 50s and 60s? Should younger patients be tested more frequently? MSKCC researchers are studying these questions to help guide the best long-term care for survivors.

While doctors seek answers as to the causes of the alarming rise in cases, health systems must pay equal attention to the different needs of these young patients, ensuring that they stay healthy during and after their illness. We need to maximize our chances of living our fullest lives after illness.

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