10 Reasons to Refer Young Adults with Cancer to a Pediatric Cancer Center

Did you know that most cancer patients in their 20s should be referred to a pediatric cancer center for treatment rather than an adult one? Yet the pediatric oncologists routinely talk to new patients who initially were sent to an adult cancer program because they were over 18 years old.

“We want every young adult with cancer to get the best care possible, access to cutting-edge clinical trials, and have the best odds at survival. That means in many instances where a patient has cancer and is in their 20s, the best place for them to go is a pediatric cancer center,” says Dr. Tyler Ketterl, medical director of the Seattle Children’s Adolescent and Young Adult Cancer Program.

Here are 10 reasons why.

  1. Young adult (YA) cancer is closer to pediatric cancer in how it behaves, and therefore how it should be treated. Most cancers in young adults — especially acute leukemias, sarcomas and brain cancer — respond best to pediatric protocols.
  2. Studies show survival rates are higher with pediatric protocols. Anecdotally, too, our pediatric oncologists who are immersed in caring for young adults, and who also treat young children and older adults see the difference that pediatric protocols make for young adults’ journey and survival.
  3. Cancer in young adults requires immediate and intense treatment. Young adults’ tumors are often acute, growing quickly and requiring fast treatment, similar to cancers in children. There is no time to wait; any delay can result in loss of bowel or bladder or other major problems. Adult programs usually deal with slow-growing cancers and aren’t set up to initiate treatment quickly. Seattle Children’s gets new patients in the door immediately and typically starts a custom care plan within a day or two.
  4. Pediatric centers’ expertise in wraparound care is especially important for YA patients. It’s hard to overstate the importance of wraparound care. Even when patients receive identical therapies that an adult hospital would give, the extra supports in a pediatric program go such a long way to keeping patients mentally healthy, preventing vomiting and anticipating the many other things that can sidetrack treatment.
  5. Fertility preservation is important to AYA patients. Seattle Children’s is a leader in our region in fertility preservation for both pediatric and adult patients undergoing cancer-directed therapy. Fertility care and preservation are included in our patients’ care plans as a matter of course. We are at the forefront of advances in this field and the only institute in the Northwest that has successfully performed ovarian tissue cryopreservation. We are excited to now offer testicular tissue cryopreservation as part of an experimental clinical trial. Two reads:  
  6. Pediatric hospitals can offer clinical trials not available at adult cancer centers. This is especially true for all YA patients up to age 35. (The National Cancer Institute definition of young adult is up to age 39.) While patients ages 30 to 39 are less likely to fit the criteria for pediatric therapies, some do (usually those with sarcomas, brain tumors, acute tumors or acute leukemias).
  7. We treat young adults as adults, not kids. Our patients are treated by staff who are familiar with their unique needs as young adults. We provide single-only inpatient rooms, a gym and other special services unique to them. Importantly, we focus on bringing what they need to them. We help them with their labs, infusions, meetings with their nutritionist, counseling from our pharmacist on how to take their drugs and more. This is particularly important for AYA patients because coordinating your own care is one of the hardest parts for an adult patient.
  8. Closing the equity gap. Proactive young adults will often find their way to pediatric care centers on their own and self-refer. Patients are less likely to end up in pediatric care if they have less education, fewer resources, less access to healthcare or come from traditionally underserved communities. From an equity standpoint, we want all young adults with cancer to know when a pediatric cancer center is best for them.
  9. Starting care at a pediatric hospital avoids a clunky, roundabout care journey and its drawbacks. Starting treatment with an adult program and then switching to pediatric is hard on patients and delays care. It can also close windows of opportunity for treatment and almost always complicates care coordination for the patient and their family even after the switch. If pediatric care is what’s needed, it’s best to start right there.
  10. It benefits future cancer patients. The AYA population is one of the most likely groups of patients NOT to be included in clinical trials, possibly explaining why survival improvements have lagged compared to younger and older patients. Our doctor-scientists are eager to close this gap by treating more YA patients, connecting them to clinical trials when appropriate and ultimately finding the best treatments for them.

Questions? Concerns? Seattle Children’s AYA providers are always happy to discuss your young adult patient. Please call our Provider-to-Provider Line at 206-987-7777. Because it’s rare that a patient under 30 would be better off at an adult cancer facility, never hesitate to call us for an opinion. If adult care is a better choice, we will direct you to UW or another adult cancer center.

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