Multidisciplinary Care Model Supports Young People with Cancer

Generation X and Millennials in the U.S. face a higher risk of many types of cancer compared to older generations. The incidence rates are rising for cancers of the breast, colon and rectum, pancreas and stomach, to name just a few. To support the unique needs of patients with early-onset cancers as well as adolescents and young adults (AYAs) with cancer, Cleveland Clinic’s Cancer Institute has developed an Integrated Program for Young People with Cancer. This team of specialists offers services that are most impactful for people aged 15-50.

“For someone who is younger, their journey will differ from that of an older patient with cancer,” explains David Liska, MD, Chair of the Department of Colorectal Surgery and Director of the Weiss Center for Hereditary GI Neoplasia and Center for Young-Onset Colorectal Cancer at Cleveland Clinic. “Our goal is to deliver the best outcomes by helping them physically and emotionally.”

Understanding distinct patient needs

Adolescents, young adults and people with “early onset” cancer can face specific challenges. They face significant issues from both a psychosocial as well as a financial toxicity standpoint. Their diagnosis may occur during what would typically be the most productive years of their lives financially, so the implications of taking time off work can be substantial. Many are caring for children and sometimes older parents.

Roughly 80% of people with young-onset colorectal cancer, for example, have children under the age of 18. They’re used to being the primary caregiver until suddenly, they’re in a situation where they are in need of care.

Being diagnosed young can also feel isolating. “It’s tough at any age but when you’re in your 20s or 30s, you may feel like you’re the only one,” says Dr. Liska. “If you look around the waiting room and everyone is much older than you, it has an impact.”

Another concern is the impact that cancer and cancer treatment may have on fertility. The program team includes onco-fertility specialists who can provide options for fertility preservation.

Genetic counseling is an important area of need, since early-onset cancers are often associated with genetic conditions. Genetic testing is important for many people with cancer, particularly our youngest patients.

As more patients are diagnosed at an early age, oncologists are discovering more about the long-term implications for adolescents and young adults with cancer. Specialized support and surveillance are needed to help survivors who may face long-term side effects and treatment complications from a young age.

Coordinated care

The Integrated Program for Young People with Cancer has established teams of specialists who are accustomed to working together to serve the AYA population and patients with different early-onset cancers in a multidisciplinary model. This approach allows teams to focus not just on their specialty but on the entirety of individual patients’ needs.

Each patient is identified by a specialized care coordinator who provides education about and access to all the potential experts the patient may need, along with support services such as social work and psychology. The coordinator is a crucial source of information for the patient and their family. They also serve as a point of contact for each patient’s primary oncologist or primary care physician, providing continuity of care throughout the patient’s lifetime.

“Dealing with the aftermath of treatment may bring its own challenges for young people,” says Dr. Liska. “The journey often doesn’t end after treatment. Patients may have ongoing health issues that require support from specialists such as reproductive health, cardiology, endocrinology or rheumatology. Our coordinators ensure patients get the ongoing support they need.”

Patients have access to cancer care as well as all of the subspecialty care and supportive resources they may need at Cleveland Clinic through the integrated program. Some patients may decide to come to Cleveland Clinic specifically to develop a treatment plan and then receive their care closer to home with local providers.

The leaders of the Integrated Program for Young People with Cancer are continuously seeking new ways to support the growing number of young people with cancer. One important approach has been to engage a patient advisory board of young people diagnosed with cancer. The advisory board regularly provides input from the patient perspective on ways to enhance the program to meet the specialized needs of the early-onset and AYA population.