More Young Adults Are Getting Cancer. This Philly Cancer Center Leads the Way in Treating Them—and Figuring Out Why

Christopher Cann, MD, Executive Director, Young Adult Cancer Program (right), and senior advisor Margaret von Mehren, MD (left), lead the Fox Chase Young Adult Cancer Program—the first in Philadelphia focused on young adults with cancer.

As cancer rates in the United States continue to rise, another concerning trend emerges: There’s a particularly sharp increase in young adults, ages 18 to 39, getting cancer. The uptick in these early onset cancers has been noticeable since the 1970s, but the last two to three decades have seen especially pronounced and accelerated numbers—particularly in breast, thyroid and colorectal cancers.

“Those born in the 1990s have a two times higher risk of colon cancer and a four times higher risk of rectal cancer than those born in the 1950s,” says Christopher Cann, MD, medical oncologist at Fox Chase Cancer Center and the Executive Director of Fox Chase’s Young Adult Cancer Program. “That drastic change has occurred even within one generation.”

Researchers haven’t yet identified what’s causing such a dramatic rise in young adult cancers—but they do know that these cancers can be particularly dangerous. “Patients under 50 experience demonstrably higher mortality rates than those with regular onset diseases. That might be due to a lack of understanding of early onset cancer: Without awareness of these diseases and their prevalence, symptoms can be harder to recognize, and outcomes can be worse,” says Margaret von Mehren, MD, Chief, Division of Sarcoma Medical Oncology and Senior Adviser to the Young Adult Cancer Program.

“If we don’t find the cancer early or start testing soon enough, patients are more likely to be diagnosed at a later stage,” Cann explains. “And the later the stage, the harder it can be to treat—and the more serious the outlook.”

And even after diagnosis, young adults face additional challenges getting care. Because they are the minority of cancer patients, traditional treatment plans and support networks aren’t designed for their needs—which can make them more likely to drop out of treatment or face harsher odds for survival.

That’s where Fox Chase’s Young Adult Cancer Program comes in. “It’s the first program in Philadelphia to specifically tap the younger patient population, with the goal of finding out why they’re getting cancer and addressing factors that make their diseases more dangerous,” says von Mehren. That means increasing research into early onset cancers and also meeting younger patients’ specific needs, such as fertility preservation and financial education. In Pennsylvania, where the incidence of early onset cancer is even higher than the national average, the mission of this program is crucial and expansive.

“I think every cancer institute needs a program designated for this population that has unique needs,” Cann says, and the broader motive of the Young Adult Cancer Program is to be that example. They’re improving care and outcomes for early onset cancer patients, inspiring hope and education for populations who are or might be impacted by these cancers, and laying the foundation for the same to be done across the country and globe.

Solving Medical Mysteries

According to Cann, there are two main goals of research into early onset cancers. First, to find out what’s causing these diseases to become so prevalent, and second, to mend the flaws in care that lead to worse outcomes for young adult patients.

On the first mission, researchers with the Young Adult Cancer Program are looking into the factors known to cause cancer and examining how young patients might interact with them. For example, Cann notes that there’s a causal link between diet, inflammation in the gut, and the development of gastrointestinal cancer, so tracking young people’s exposure to inflammatory triggers, and measuring whether that exposure has increased in recent years, might help explain the rise in cancer.

In the meantime, the second goal—to understand and address how early onset cancers might respond better to different treatment approaches—can make a more immediate impact. That’s especially important because, according to Cann, early onset cancer may not be biologically more dangerous than average onset cancers, so the higher mortality rates may point to an issue in care.

“That is why younger patients might be better suited for more nuanced care that attempts to mitigate long term side effects while maintaining efficacy of treatment, and why it’s important that clinical trials not only include young patients, but focus specifically on their needs,” says Cann. For example, Fox Chase’s program is looking into “chemo brain,” cognitive defects that occur after chemotherapy and can linger for years.

“Chemo brain can be destructive to young adults who might be in the middle of their education or starting their career,” Cann explains. The same is true for issues such as cachexia, which causes loss of muscle mass after treatment. By not only collecting data from its patients, but also promoting their involvement in ongoing studies, Fox Chase is moving the needle on both of those fronts.

Dr. Cann offers every young adult patient comprehensive support.

Increasing Early Detection

Though we don’t yet have all the answers as to the origins of early onset cancer, physicians can act now to improve care for their patients. That begins by educating both patients and physicians on the symptoms, risks and prevalence of early onset cancer, so they can more aptly judge when to suspect it. “That’s especially pertinent because younger adults aren’t traditional cancer patients, and their symptoms might seem benign,” says von Mehren.

For example, common symptoms for early onset colon cancer include bloating, abdominal pain and constipation, but each of those symptoms can indicate a wide range of conditions. So, when younger patients present with these issues, screening for colon cancer might not be a doctor’s first recommendation–but with rising cases, it’s becoming more critical to do so.

“In a large patient survey, two thirds of patients with early onset colorectal cancer saw two or more physicians before they were diagnosed, and 41 percent waited more than six months before seeking medical attention,” Cann says. “This tells me that more patients need to know this is an issue and physicians need to have a lower threshold to investigate potentially vague symptoms.”

Genetic counselors also play a role in increasing screening, and they’re a key part of the Young Adult Cancer Program. According to Cann, if a person has a first degree relative with colorectal cancer or advanced or high risk polyps, doctors recommend screening begin at age 40, or 10 years before the first-degree relative’s diagnosis, whichever is earlier. With this knowledge, genetic counselors at Fox Chase make sure that the right patients get screened, and that patients’ family members can also control their risk.

“Screening also helps a patient’s siblings, parents and children to know if there’s something in their gene pool that enables them to get screened earlier,” Cann says.

The Young Adult Cancer Program helps patients enable fertility after treatment.

Designing the Right Care

Cancer touches many areas of a patient’s life, and traditional support networks for those areas aren’t necessarily designed for early onset patients. The Young Adult Cancer Program is aiming to change that.

One change is through addressing the impact chemotherapy can have on fertility and reproductive health, which can be major concerns to younger patients. Through an electronic medical record intervention, the Young Adult Cancer Program identifies patients within this age group, encouraging provider conversations with patients on the risks of treatment on fertility and promotes expedited referral to our onco-fertility team and fertility specialists.

“Since we developed this program, the number of referrals has increased by 400 percent, and the amount of preservation we’ve seen in the last six months has already exceeded what we did on average over the past 10 to 15 years,” Cann says.

In addition to reproductive care, Fox Chase has helped patients navigate the financial cost of cancer—which often impacts younger people differently. They might be pursuing higher education or paying off debt from higher education, or be more unstable in their career and have less reliable insurance. Navigators with the program connect these patients with financial counselors, who offer education and point them to institutional resources or charities that can provide extra funding. That support also helps patients avoid any debts and financial burdens that make adjusting to normal life after treatment more difficult.

And to deal with the experience of cancer more broadly, Fox Chase matches patients with social workers, and psychologists and psychiatrists for specific psychiatric issues. Support groups for specific demographics, such as college students and young parents, can help patients feel less alone as they reshape their life around their disease—and that feeling of community is powerful.

“Providing designated, community support in these areas has been shown to decrease depression and anxiety, and potentially increase overall outcomes for these patients,” Cann says. “Any way that I can help spread awareness, contribute to research or spark someone’s interest in developing a similar program, that’s my goal.”

If you or a loved one are interested in learning more about how Fox Chase is changing the way cancer is treated in young adults, or to make an appointment with one of Fox Chase Cancer Center’s Young Adult Program providers, visit foxchase.org/young-adult.