Dr. Andrew Evens, a leading oncologist from Rutgers Cancer Institute and Jack & Sheryl Morris Cancer Center, recently highlighted the significant challenges facing adolescent and young adult (AYA) patients with non-Hodgkin lymphoma (NHL) and emphasized the need for specialized approaches to their care.
Unique Challenges for AYA NHL Patients
AYA patients, defined as those between 15-39 years old, face distinct barriers to optimal NHL care. "It starts with access and insurance," Dr. Evens explained. "Many don't have a primary care provider that they're seeing once or twice a year and doing exams. Therefore, they might let something persist longer than they should."
Unlike more common cancers such as breast, colon, or prostate cancer, NHL lacks established screening protocols. "There are not real screening strategies, but in a way, that's not a surprise," noted Dr. Evens. "Most other cancers don't have a screening, partly because we don't have a real test to do it. Also, the incidence is not as high."
This absence of screening tools makes early detection particularly challenging, especially for a population that may not be regularly engaged with healthcare systems.
Treatment Approaches and Biological Considerations
A significant concern in AYA NHL care is the current "one-size-fits-all" treatment approach. Dr. Evens pointed out that clinicians generally don't approach NHL treatment differently in AYA populations compared to older patients, which "might be an issue."
"We've had a bit of one-size-fits-all treatment through the lens of adult oncology. That may be right and that may not be right," he stated. This approach persists despite emerging evidence suggesting potential biological differences in lymphomas affecting younger patients.
The situation is further complicated by historical differences in treatment protocols between pediatric and adult oncologists. "For a singular entity, I'll use Hodgkin lymphoma as an example, they have historically, for the preceding 40-plus years, used different treatments for the same patient age group," Dr. Evens explained.
Research Gaps and Future Directions
Dr. Evens emphasized that more research is needed to determine whether distinct treatment approaches should be implemented for AYA NHL patients. "We don't yet have enough actionable information when it comes to biology to say it should be treated different, but there's enough red flags to say something different is going on."
He called for dedicated research efforts to study tumor tissue and understand potential biological differences based on age. "Even if there are biologic differences, you can't assume the treatment should be different, you need to test it," he added, highlighting the need for prospective clinical trials to evaluate whether targeted therapies might be more effective for this population.
Resource Limitations and Support Systems
The interview also revealed significant gaps in resources specifically tailored for AYA NHL patients. While organizations like the Lymphoma Research Foundation and American Cancer Society provide general information, Dr. Evens noted that "a lot of that information is not tailored in any form or fashion to AYAs."
"We need more to address many of the issues from the very beginning, not just the biology and the diagnosis, but some of the social factors, access to health care, and financial toxicity," he stated. These resources would ideally help patients navigate insurance challenges, financial aspects of treatment, and survivorship care.
Some institutions have developed specialized support systems. Dr. Evens mentioned that Rutgers Cancer Institute, as a large cancer center, offers various resources, and their pediatric colleagues at RWJBarnabas Health have a program called Child Life Services with "extra social workers, oncologists, psychologists, and some financial navigation services for patients."
The Role of Primary Care Providers
Given the lack of screening protocols and the challenges in access to specialized care, primary care providers play a crucial role in addressing the needs of AYA NHL patients. Their ability to recognize persistent symptoms and facilitate timely referrals can be critical in the early detection and management of lymphoma in this population.
Dr. Evens expressed hope that barriers to care "can improve over time," not just at academic centers but also in community oncology settings. He suggested that even if community practices don't have in-house resources, they could direct patients to online information or remote counseling services.
As AYA Cancer Awareness Week (April 1-7) highlights these issues, the call for increased attention to the unique needs of young adults with NHL becomes even more relevant. Addressing the biological, clinical, and social aspects of NHL in this population will require coordinated efforts across the healthcare spectrum to improve outcomes and quality of life for these patients.
