Yale program treats young cancer patients

Recognizing that young adults diagnosed with cancer show poorer outcomes post-treatment, Yale-New Haven Hospital has initiated a program dedicated to psychosocial treatment for this vulnerable population.

The Adolescent Young Adult (AYA) Cancer Psychosocial Program at the hospital’s Smilow Cancer Center will offer services to all patients age 15-39 beginning with the initial diagnosis as a way to improve outcomes.

According to a University of Michigan study published in Psycho-Oncology, 39 percent of all adolescents and young adults with cancer reported moderate to severe levels of psychological distress six months after diagnosis.

Unlike with adult cancer patients, whose distress levels off after six months, those numbers rose to 44 percent after 12 months.

“This age group has the poorest outcomes,” said Kathi Croce, Ph.D., assistant clinical professor of psychology at Yale School of Medicine, who was brought in to develop the AYA program at Yale-New Haven.
“They are more likely to get PTSD. One-third struggle to keep up with treatment and 15 percent do not get special services. Fifty percent do not pursue cancer related follow-up.”

Compared to their peers without cancer, AYA cancer survivors are less likely to go to college and get married, she added. A major problem for this age group, beyond fears of mortality and the difficulty of the treatment itself, is that these issues come during a crucial period of development.

With the side effects of the disease and the treatment, it can be difficult for young adults to remain close to peers, experiment with dating, keep up with schoolwork, learn the responsibilities of employment and develop a normal level of self-knowledge.

“This is a vulnerable time of development when major milestones are being experienced and they can be knocked off track,” said Croce.

Modeled on programs found in London, Australia, Seattle and Florida, the new program will provide evidence-based, age-appropriate treatment as well as run clinical trials. What stands out is the plan to screen every AYA patient diagnosed at the hospital and to run systematic follow-up screenings, whether the patient is referred for further treatment or not.

“They may look fine when they first come in, resilient and strong,” said Croce, “but they can struggle later when the chemo hits or when their body changes. We know their resilience and needs change at different points in time, so we assess them again and teach them the skills we know they are going to need as they move forward.”

The program has begun to see patients and should be formally introduced this spring with plans for dedicated socialization, therapy and inpatient spaces scheduled for 2017.

While there are other programs for this age group in the area, Croce believes it is the only one that will automatically screen every patient coming through the hospital. It is a program she hopes to see expand both to other hospitals and with other age groups within Yale-New Haven.

“I am very excited about this work,” she said. “This is a long overdue model and something that every person deserves.”