Spotlight on AYA Cancer Care: The Reasons Some Young Adults Choose to Receive Care at a Pediatric Hospital
November 1, 2023
Newly diagnosed cancer patients in their 20s may be referred to a pediatric cancer center for treatment rather than an adult cancer center. Some of the nation’s top children’s hospitals have Adolescent and Young Adult (AYA) programs specifically designed for this special population.
“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. In many cases, for a variety of reasons, the best place for them to go is a pediatric cancer center,” says Dr. Tyler Ketterl, medical director of the Seattle Children’s AYA Cancer Program. Pediatric oncologists at Seattle Children’s Cancer and Blood Disorders Center (CBDC) routinely treat patients in their late teens and 20s and even some patients in their 30s.
Dr. Ketterl lists the primary reasons that pediatric treatment is the best choice for many young adults.
- Many young adult (YA) cancers are closer to pediatric cancer in how they behave and therefore how they should be treated. Many cancers in young adults — especially acute leukemias, sarcomas and brain cancer — respond best to pediatric protocols.
- Cancer in young adults often requires immediate and intense treatment. Most adult-onset cancers are different from the cancers diagnosed in pediatrics; treatments are radically different, and the timelines to initiate those treatments are also different. Children, adolescents and young adults with cancer frequently present much sicker and thus require rapid workups and initiation of treatment. Any change in treatment timelines can have major impacts on health. The team at Seattle Children’s gets new patients in the door quickly and typically starts a custom care plan within a few days to a week.
- Pediatric centers’ expertise in wraparound care is especially important for young adult patients. Pediatric and AYA cancer teams have specialists to help with the emotional aspects of a diagnosis of cancer that may affect teenagers and young adults differently than older adults. Read more in ‘An Integral Part of Cancer Care’: How a Seattle Children’s Oncologist Researches and Advocates for Body-Mind Health.
- 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 treatment. 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 institution in the Northwest that performs pediatric and adolescent ovarian tissue cryopreservation. We also offer testicular tissue cryopreservation as part of an experimental clinical trial.
- Pediatric hospitals offer clinical trials that are generally not available at adult cancer centers. This includes trials for patients up to age 35 diagnosed with cancers typically seen in children. The National Cancer Institute definition of a 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), and when they do, they should have access to a pediatric oncology service.
- We treat young adults as adults with unique needs. Our patients are treated by staff who are familiar with their unique needs as young adults. We provide all patients with private inpatient rooms, a gym and other special services. We help them navigate everything involved with complex cancer care. This is particularly important for AYA patients because coordinating your own care is one of the hardest parts for an adult patient, and AYA patients are not quite fully launched adults!
- Participating in clinical trials benefits future cancer patients. The AYA population is one of the most likely groups of patients NOT to be included in many clinical trials, possibly explaining why survival improvements have lagged compared to younger and older patients. Our research teams are eager to close this gap by treating more young adult patients, connecting them to clinical trials when appropriate and ultimately finding the best treatments for them.
If you have questions about cancer care for a young adult patient, our AYA providers are always happy to talk with you. Please call our Provider-to-Provider Line at 206-987-7777. Depending on the cancer diagnosis and medical history, some patients under 30 may benefit from care at a pediatric cancer facility. We encourage providers to never hesitate to call us for an opinion. If adult care is a better choice, we will absolutely direct you to the Fred Hutch Cancer Center for specialized care!
Clinical Trials Open to AYA Patients
Below are some of the special trials we have available for AYA patients at Seattle Children’s.
AGCT1531
A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients with Germ Cell Tumors
Low Risk Stratum (Stage I Ovarian Immature Teratoma and Stage I Non-Seminoma or Seminoma Malignant GCT) – No age limit
Standard Risk 2: 11 to 25 years of age
Contact: Tyler Ketterl, MD; tyler.ketterl@seattlechildrens.org or call 206-987-2106, option 8
AGCT1532
Phase 3 Accelerated BEP Trial: A Randomized Phase 3 Trial of Accelerated Versus Standard BEP Chemotherapy for Patients With Intermediate and Poor-Risk Metastatic Germ Cell Tumors
Age limit: ≥11 and ≤45 years of age
Contact: Tyler Ketterl, MD; tyler.ketterl@seattlechildrens.org or call 206-987-2106, option 8
ARST2031
A Randomized Phase 3 Trial of Vinorelbine, Dactinomycin, and Cyclophosphamide (VINO-AC) Plus Maintenance Chemotherapy With Vinorelbine and Oral Cyclophosphamide (VINO-CPO) vs Vincristine, Dactinomycin and Cyclophosphamide (VAC) Plus VINO-CPO Maintenance in Patients With High Risk Rhabdomyosarcoma (HR-RMS)
Age limit: 0 to 50 years of age
Contact: Katie Albert, MD; katie.albert@seattlechildrens.org or call 206-987-2106, option 8
AOST2031
A Phase 3 Randomized Controlled Trial Comparing Open vs Thoracoscopic Management of Pulmonary Metastases in Patients With Osteosarcoma
Age: <50 years of age
Contact: Katie Albert, MD; katie.albert@seattlechildrens.org
AOST2032
A Feasibility and Randomized Phase 2/3 Study of the VEFGR2/MET Inhibitor Cabozantinib in Combination With Cytotoxic Chemotherapy for Newly Diagnosed Osteosarcoma.
Age: <40 years of age
Contact: Katie Albert, MD; katie.albert@seattlechildrens.org
AALL1732
A Phase 3 Randomized Trial of Inotuzumab Ozogamicin (IND#:133494, NSC#: 772518) for Newly Diagnosed High-Risk B-ALL; Risk-Adapted Post-Induction Therapy for High-Risk B-ALL, Mixed Phenotype Acute Leukemia, and Disseminated B-LLy
Age: <25 years who meet criteria for National Cancer Institute High Risk ALL
Contact: Amy Tellinghuisen, MD: amy.tellinghuisen@seattlechildrens.org
AAML1831
A Phase 3 Randomized Trial For Patients With De Novo AML Comparing Standard Therapy Including Gemtuzumab Ozogamicin GO to CPX-351 With GO, and the Addition of the FLT3 Inhibitor Gilteritinib for Patients With FLT3 Mutations
Age: <22 years
Contact: Todd Cooper, MD: todd.cooper@seattlechildrens.org