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Focus on Adolescents and Young Adults With Cancer

Network - Winter 2011

Anna Franklin, M.D.
We asked Anna Franklin, M.D., assistant professor in the Department of Pediatrics and medical director of the Adolescent and Young Adult (AYA) Program at MD Anderson, about the concerns of young adult (ages 15-39) cancer patients and survivors and how her team helps them cope.

What special issues do young adults with cancer face?

Before a cancer diagnosis, most young adults have never experienced a major illness, much less a life-threatening one. They typically have a sense of invincibility, and a cancer diagnosis immediately forces them to consider their mortality.

As part of normal development, many adolescents and young adults are transitioning to independence. Suddenly cancer and its treatment force many of our patients to become completely dependent on others again. They may need to move back in with their parents or have someone take care of simple daily needs like bathing, dressing and eating.

These are major concerns, but AYAs may also face other issues, such as altered body image, impaired fertility, a sense of isolation, depression, anxiety, little or no health insurance and unfamiliarity with the health care system. They also need to figure out how to continue their education or career development while being treated for cancer.

How does your team help them address and deal with these issues?

We try to help AYAs continue to lead as normal a life as possible. We encourage them to continue as many of their activities as they feel up to while they’re undergoing treatment. And we encourage them to speak up and be their own advocates.

The Anderson Network, which provides support to patients, survivors and caregivers, has a special program called Cancer180 that organizes social outings for AYA cancer patients. They go to professional sporting events, cooking classes, video arcades, bowling — or just hang out at a restaurant or bar. It helps them realize they’re not the only twentysomethings with cancer.

Are young adults open about their issues and their worries about long-term side effects?

Like most people their age, AYAs with cancer are not open with older adults about their sexuality. Asking them about their relationships is crucial because they seldom volunteer the information.

Doctors and nurses mustn’t assume young adult patients know the risks associated with treatment, such as decreased fertility or other late effects; it’s our responsibility to educate patients. We should also educate patients about the screenings they need to monitor for long-term side effects, as well as what they can do to minimize their risks.

Is there resistance among this population to crucial follow-up screenings? If so, how do you deal with it?

Adherence to treatment and follow-up can be a significant issue in this age group. Once patients feel better, they may stop taking medications or coming to appointments because they don’t want to have cancer.

I’ve found the best approach is to ask patients directly why they’re not adhering to the health care team’s recommendations. The answers have ranged from being “tired of having cancer” and wanting a sense of normalcy to not having the money to pay for parking or prescriptions.

Once we know what the issue is, we can garner resources from MD Anderson and the community to help them stay on track.

© 2015 The University of Texas MD Anderson Cancer Center