Lisa G. Roth, MD
As awareness of the unique needs of adolescents and young adults (AYA) with cancer increases, there are now clinical trials in Hodgkin lymphoma specifically focused on this patient population.
For example, a phase II trial is investigating the efficacy of combination chemotherapy with or without radiation therapy in young patients with favorable-risk Hodgkin lymphoma (NCT00846742). Eligible patients must be 21 years or older—including a broader age group than what has been observed in the past.
Patients in this age range are often given differing treatments based on whether they visit with a pediatric oncologist or medical oncologist, explains Lisa G. Roth, MD. Now, to address the psychosocial needs and additional aspects of AYA patients, Weill Cornell Medicine’s Center for Lymphoma formed the Adolescent and Young Adult Lymphoma Program.
“There are a lot of opportunities when you look globally at the options that you have for patients in this age range,” said Roth, an assistant professor of pediatrics, Department of Pediatrics and Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital. “Don’t limit yourself to what’s happening in the field of pediatric Hodgkin lymphoma or in adult Hodgkin lymphoma. When these groups work together, it really expands the opportunities you have for treatment options for these patients.”
Roth discusses the challenges of treating adolescent and young adult patients with Hodgkin lymphoma and the benefits of having a multidisciplinary approach with this population. She shared this insight during the 2017 OncLive®
State of the Science SummitTM
on Hematologic Malignancies.
OncLive: What did you discuss regarding AYA patients with Hodgkin lymphoma?
It is a unique age range, and an age range that is particularly relevant in Hodgkin lymphoma, where the peak age incidence is actually young adults. They have unique medical and psychosocial needs relative to younger pediatric patients, as well as the older adult oncology patients.
What we talked about is some of the differences in treatment approaches and how, specifically, to approach patients in this unique age range where it’s kind of a unique situation where the patients in this age range might walk into a pediatric oncologist or a medical oncologist and receive vastly different treatments for the exact same diagnosis. We went through those specific issues, what considerations are relevant for this age group, and how you should approach treatment for patients in the AYA age range.
How do you decide if an AYA patient should go to a pediatric or medical oncologist?
That is a very good question and there really is not a right answer here. What we have done at Weill Cornell Medicine is to create an AYA Lymphoma Program. It is a collaboration between the pediatric oncologists and the medical oncologists so that we can work together to decide what’s optimal for each patient. It is a unique opportunity to provide care for them that is specific to the needs of the patients in this age range.
That includes not only optimizing their medical treatment, but addressing concerns, such as fertility preservation, minimizing long-term effects, and the psychosocial aspects of being a young adult with cancer. You might be in the middle of school or just starting a first job, so how to navigate and cope with all of those things is unique to that age group. The AYA Lymphoma Program that we have has a specific multidisciplinary approach and clinicians, social workers, psychologists, and a fertility preservation team work together to optimize care for these patients.
What advice do you have for community oncologists who are treating these AYA patients with Hodgkin lymphoma?
They really do have unique psychosocial needs that are different than younger patients and from adult patients. All of these patients can feel very isolated because they don’t quite fit in with the other people that they’re seeing in the waiting room being treated for other diagnoses. A specialized center that focuses on care in this age group truly does serve to their advantage, where you can have someone focusing with experience specific to this age group and directing them to the support networks that can help them through this.
For this age group, it’s very different than what a support network would look like for a pediatric patient and an older patient. You are getting them the supportive care they need, as well as the counseling for optimal therapy with regard to minimizing long-term toxicity, optimizing their fertility preservation, and planning for what we expect to be many life years ahead of their treatment. It is very important.