Cancer before 40: Mayo Clinic expert shares 3 topics that younger patients often want to discuss

PHOENIX — Dr. Allison Rosenthal's experience facing a leukemia diagnosis while in medical school inspired her to pursue a career fighting cancer. It also gave her insight into aspects of life with cancer for people under 40. Now, Dr. Rosenthal is among the leaders of an effort at Mayo Clinic Comprehensive Cancer Center to help younger adults and older teens receive age-appropriate care and support. In this expert alert, Dr. Rosenthal shares three topics that younger people with cancer often want to discuss with their healthcare teams.

"I have a very big passion and motivation to take care of our younger cancer patients," Dr. Rosenthal explains. "These are some of the people who need the most support after treatment."

Advances in cancer treatments have made many of the cancers most common in younger people highly treatable and often curable, Dr. Rosenthal says.

Worldwide, roughly 1.3 million people ages 15 to 39 were diagnosed with cancer in 2022, the most recent statistics available, according to the International Agency for Research on Cancer. The most common cancers in that age group were breast, thyroid, cervical, testicular, ovarian, blood cancers (leukemias and lymphomas) and colorectal, agency figures show.

While long-term disease control or a cure is the objective, completing treatment doesn't necessarily mean that a younger person's experience with cancer is over, she adds.

"That means many adolescent or young adult cancer patients go on to live long lives, leaving them to navigate cancer survivorship for decades," says Dr. Rosenthal, a hematologist and oncologist at Mayo Clinic in Phoenix. "There is the emotional impact that comes along with having experienced cancer, and that can be significant as they try to move forward in life. And there are also the physical effects and the long-lasting impact of that."

In addition to being a time of transition from pediatric medical care to adult care, the late teens and young adulthood typically are times of major life changes, adding challenges on top of cancer. The adolescent and young adult cancer program "is predicated on the idea that centering care around their unique needs improves their experience and outcomes," Dr. Rosenthal explains. In addition to individual feedback from patients, the program has a patient advisory council whose participants share what is important to them.

"We've tried to prioritize what we're working on based on the feedback we're getting from our patients who are in the midst of this experience," she says.

Dr. Rosenthal has observed that questions on these three topics are often on the minds of patients in their late teens, 20s and 30s during and after cancer treatment:

• Wellness behaviors and exercise.

"There are guidelines and recommendations for lifestyle choices including exercise, but it's a little bit hard to access those and to hold themselves accountable to pursue them," Dr. Rosenthal says.

• Connection with peers with cancer and additional support to know that they're not alone.

"And when their peers move on, to feel that they aren't left behind," Dr. Rosenthal explains.

• Sexual health and relationships.

"It's difficult for people to navigate," Dr. Rosenthal says. "It can be uncomfortable to ask about. It's hard to tell their peers about. There's a lot of work going into what we can proactively do to best support them."

Fertility can be impacted by cancer and its treatment, making conversations about fertility preservation important.

Another priority for the Adolescent and Young Adult Cancer Program is advance care planning. For older people with advanced cancers, involving palliative care earlier often helps them live longer and have a better quality of life, Dr. Rosenthal notes. That same approach could help younger patients.

"We're working on an advance care planning project specifically for young people with advanced cancers, to empower them to have a voice when they have time to have a voice, and not have that taken from them as well," Dr. Rosenthal says. "I know there's so much that can be done. Long-term outcomes, survivorship, quality of life — all of that is very important."

The program takes a multidisciplinary approach, including cancer specialists, social workers, health psychologists, and financial and vocational counselors.

"We're really fortunate that the majority of young adult patients who get cancer care are going to do well in the long term; there's going to be a lot of long-term survivors," Dr. Rosenthal says. "But if we aren't paying attention to the long-term treatment side effects, quality of life and the monitoring and maintenance of health, then we aren't providing the full service for these patients that they really deserve."

JOURNALISTS: Global, regional and national statistics on cancer in people ages 15 to 39 are available here.

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