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Recent years have seen a concerning rise in cancer diagnoses among young adults across all cancer types. While cancer is often associated with older populations, research shows that younger adults are increasingly diagnosed with a range of cancers – including breast, colorectal, lymphoma, melanoma and sarcoma, among others.
This surge in diagnoses highlights the urgent need for specialized care and resources tailored to the needs of cancer patients aged 18-39. To optimize the treatment experience and improve the cancer journey for these patients, Fox Chase Cancer Center developed its Young Adult Cancer Program. Directed by Christopher Cann, MD, whose treatment focus includes gastrointestinal cancers and young adult oncology, and supported by senior advisor Margaret von Mehren, MD, Chief of the Sarcoma Medical Oncology Division, this program is the first in the Philadelphia area created solely for young adult patients.
The care team of the Young Adult Cancer Program understands and addresses the special concerns these patients face – navigating work or school considerations, fertility and sexual health, financial implications, relationship dynamics, psychosocial issues, and other unique challenges stemming from their medical treatment.
Now, through several collaborative studies by clinicians and scientists that prioritize oncofertility, cognitive impairment, and the role of the microbiome in early-onset cancer, Fox Chase is combining targeted support with rigorous scientific investigation to redefine standards in this unique patient population.
One of the major concerns for young adults diagnosed with cancer is how treatment may impact their fertility. Many patients in their 20s and 30s are still planning to start families, and cancer treatment can have lasting effects on their ability to conceive.
As such, the first planned study for the Young Adult Cancer Program involves a randomized clinical trial measuring the program’s impact on treatment adherence and oncofertility access, compared with patients undergoing standard of care (outside the program). Drs. Cann and von Mehren hope to assess whether a young adult program offering relevant supportive services can increase the time that patients are on a full therapeutic dose. These services would include outreach to share information on the potential effects of treatment, fertility preservation options, and available financial resources.
“The goal would be to limit the dose delays or dose reductions on chemotherapy, which can be paramount to patient treatment as well as the ability for referrals to our oncofertility team and fertility preservation,” Dr. Cann said.
The goal of the Fox Chase oncofertility team includes connecting patients with fertility specialists within 24 hours of an oncofertility referral, providing timely guidance on preservation techniques such as sperm or egg freezing. A prompt response ensures that young adults can make informed decisions about their family plans before beginning treatment.
The second, nationally coordinated study involves using a drug in combination with chemotherapy that may assist with maintaining cognition, Dr. Cann said.
“ ‘Chemo brain’ is a big issue not only for average age onset patients, but young adults as well – especially during this pivotal time in their psychosocial development, education and career development,” he said. “Preserving our patients’ cognition throughout treatment is paramount to ensuring a good quality of life.”
The Young Adult Cancer team will examine the use of this drug and chemotherapy combination in the neoadjuvant or adjuvant setting, meaning treatment occurring before or after surgery. In comparing this study’s results with those of patients who do not receive the drug, the team must conduct quick assessments – immediately after chemotherapy and six months later, because there is evidence that cognition can decline six months after any type of chemotherapy, Dr. Cann said. But the team hopes to see indications that this drug-chemo combination can preserve or even improve patient cognition.
In addition, Drs. Cann and von Mehren hope to leverage the expertise of the Fox Chase radiology team to conduct imaging tests that help evaluate any changes within the volume of the brain or whether other changes have occurred, as previous evidence has suggested.
The Young Adult Cancer team is also joining a comprehensive microbiome study that originated at Vanderbilt University Medical Center and includes participants from the United States, Europe, the Middle East and Australia.
The study compares the microbiome of young adult colorectal cancer patients with that of average age onset patients and normal controls. It aims to provide a better understanding of why colorectal cancer diagnoses are increasing for young adult patients, and whether these diagnoses involve differing factors worldwide.
Bacteria and other microbial organisms in the gut microbiome are crucial to human health. Many experts, including those at Fox Chase, can point to research demonstrating that changes in gut bacteria, along with poor diet and rising obesity rates, may be significant contributors to colorectal cancer in young adults – but all these factors may play varied roles among global populations.
With deep expertise in sarcoma, which is among the more common cancers in young adults, Dr. von Mehren has spent years focusing on this patient population. She collaborates closely with scientists to develop new therapies and treatment approaches. She served as a founding member of the NCCN Adolescent and Young Adult Oncology Panel.
“The infrastructure that Dr. Cann has put into place is trying to make standard of care what we think should be for these patients, as well as developing research questions that are unique for this population,” she said. “As this young adult program blossoms, we know there are other individuals at the Cancer Center who are interested, on the clinical side as well as research-wise. It's going to position us to expand our research moving forward.”
As the program evolves, Fox Chase plans to expand it based on patient feedback, ensuring that resources are responsive to the needs of this population. While the program initially focused on gastrointestinal cancer, which is Dr. Cann’s expertise, plans are in place to extend it to other types of cancer, ensuring that all young adults diagnosed with cancer can benefit from the program’s resources, research and clinical trial options.
“We’re continually assessing the needs of our patients and will adjust the program to meet those demands,” Dr. Cann said. “This is a time in life when patients are already dealing with significant life changes, so we’ve made sure to build a team that can address these particular challenges.”
Balancing a cancer diagnosis and the side effects of treatment while managing the stressors of young adulthood is extremely challenging. The Fox Chase Young Adult Cancer Program is bridging research and discovery with patient care – setting a new standard in precision oncology and survivorship for this underserved patient population.
The insights gleaned from their laboratory studies can be directly applied to the bedside while safely evaluating novel approaches to preventing and treating cancer through clinical trials, which may eventually drive standard protocols with far-reaching implications.
“The Young Adult Cancer Program could set an example for other institutions nationwide. We can improve and ultimately meet the goal of providing care throughout the country for everyone within this population,” Dr. Cann said.
That’s the benefit of Fox Chase’s elite standing as an NCI-designated Cancer Center: Our research is led by extraordinarily talented scientists who work in an ideal environment for fundamentally important discoveries. With additional support from our partnership with Temple University Health System’s oncology research, treatment and prevention programs, Fox Chase research makes a world of difference in Northeast Philadelphia and all other communities that we serve.
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