Young Adults & Cancer
Nearly 70,000 young adults are diagnosed with cancer in the United States each year.
That’s a staggering number.
A cancer diagnosis between the ages of 15 and 39 is nearly eight times more common than such a diagnosis during the first 15 years of life.
The cancers most commonly diagnosed in young adults are lymphoma, leukemia, germ cell tumors (ovarian and testicular cancers), melanoma, sarcoma, breast cancer, cervical cancer, liver cancer, thyroid cancer, and colorectal cancer.
Today cancer is the leading disease killer among 20- to 39-year-olds.
Despite advances in early detection, treatment, and prevention, there’s been no improvement within the last 30 years in survival rates for this particular age group — and in fact, the gap between the survival rates of young adults and those of cancer patients in other age groups is widening.
The Cancer Story
In 2006, for the first time in recorded history, the number of annual cancer deaths in the United States decreased. Death rates from cancer have been declining since 1993, but this marked the first decline in the actual number of cancer deaths in over 70 years.
However, not all segments of the U.S. population have benefited equally from these advances…the strides that have served to make cancer a chronic disease for many have generally bypassed young adults. The President’s Cancer Panel reports adolescents and young adults have been studied far less than other segments of the population. The health care and survivorship needs of this group are not well understood and poorly served.
There are also several clinical and social factors that contribute to the lack of progress for this age group:
Delayed diagnosis. This is a result of a combination of factors, including low clinical suspicion among medical professionals, feelings of invincibility among young adults, and unreliable access to medical care.
Lack of (adequate) health insurance. Young adults are the highest uninsured and underinsured group in the United States.
In a 2006 cover story, New York Magazine noted that young adults are the fastest-growing segment of America’s uninsured population. This lack of health care coverage is attributed to the fact that employer health coverage is not necessarily standard practice in today’s working world, and that “for the young who don’t luck into a job that offers coverage, a certain outlook becomes inevitable: Premiums are a fortune, you can barely pay your rent, you rarely need a doctor, you decide to gamble.”
This lack of adequate coverage may result in lost lives, decreased economic productivity, underutilization of essential services, and inefficient and poorly-coordinated care. As a result of being uninsured, young adults may not feel empowered to seek care, may not be financially capable of paying the bills that may be incurred through medical care, and may not have regular access to a general practitioner. All of this contributes to the staggering rates of delayed diagnosis in this population.
Clinical trial participation. In addition to contributing to medical research, participants in clinical trials gain access to new research treatments before they are widely available, and are eligible to obtain expert medical care at leading health care facilities during the trial. Statistics show young adults have the lowest participation rate in clinical trials of any age group.
Biological differences. Cancer in young adults often presents itself quite differently than in other age groups. It is suspected that the distinctive biology of this age group results in unique histological subtypes and rare hereditary tumors, in addition to the role hormonal differences may play in tumor development and biology. In addition, exposure to environmental risks (like the sun and the Human Papilloma Virus (HPV)) are particularly prevalent in this age group.
Treatment. There remains an uncertainty about where to treat young adults: Should they be considered part of pediatric or adult care? No medical profession owns this issue, and this results in a lack of professional mentors and an official discipline. This is one of the greatest contributing factors to young adults falling through the cracks in the system. Additionally, there are no established treatment protocols for this age group, and a great deal of mystery still surrounds issues such as toxicity tolerance and how it impacts treatment for this population.
Historically decentralized advocacy efforts. There are a handful of advocacy organizations dedicated to the cause of supporting and connecting young adults affected by cancer. However, until recently, advocacy efforts existed largely in silos, and no single organization had the momentum to affect the change that is necessary.
These factors, among others, have led to cancer centers establishing young adult cancer programs in recent years. Young adult oncology is even becoming a specialized area of clinical focus.
Unique Concerns & Obstacles
Young adults dealing with cancer face a myriad of social, psychological, and of course medical hurdles.
This group demonstrates distinctly different psychological needs and issues based on their unique age-related development, as the “young adult” segment includes high school and college students as well as adults who have spouses and are parents of young children.
Young adults fighting cancer often confront the loss of a sense of independence and the natural progression of maturity, as well as concerns over changes in physical appearance, fertility, and relationships. Additionally they face obstacles such as education, insurance, and employment.
While most other young adults are leading healthy, active, and busy lives, a cancer diagnosis often makes it difficult to keep up socially, academically, and professionally, as well as relate to others. It can be difficult for young adults with cancer to find strong, reliable peer support as they face their illness… and this can lead to feelings of despair and isolation.
As advancements in research, medicine, and treatment occur, The Ulman Cancer Fund remains steadfast in its mission to work for and with young adults and their families as they battle this disease by offering support, resources, and a community that recognizes the profound effect of cancer on young people’s lives.
Cancer is the name for over 100 different diseases in which normal cells begin to change and grow uncontrollably. Cancer may form anywhere in the body and can spread throughout the body.
Cancer in young adults
Although cancer is frequently thought of as a disease of the elderly or the very young, the reality is that more than 70,000 young adults are diagnosed with cancer in the United States each year. In fact, a cancer diagnosis between the ages of 15 and 40 is nearly eight times more common than such a diagnosis during the first 15 years of life.
The most common young adult cancers
According to the National Cancer Institute, the cancers most commonly diagnosed in young adults are:
A cancer of the immune system, commonly divided into Hodgkin and non-Hodgkin lymphoma.
Hodgkin lymphoma most commonly affects lymph nodes, groups of bean-shaped organs that are found in clusters in the abdomen, groin, pelvis, underarms, and neck. There are different kinds of Hodgkin lymphoma, and the type of cancer will determine the course of treatment used by doctors.
Non-Hodgkin lymphoma refers to many different types of cancers of the lymph system, which can start anywhere and spread to any area of the body. Again, the type of cancer involved will determine the treatment.
Leukemias are cancers of the blood cells. The type of leukemia depends on the kind of blood cell that becomes cancerous. Treatment varies by type. There are four main types of leukemia diagnosed in young adults:
Acute lymphocytic leukemia (ALL)
A cancer of the lymphocytes, a type of white blood cell involved in the body’s immune system. In people with ALL, new lymphocytes do not develop into mature cells, but remain as immature cells called lymphoblasts, which crowd out healthy blood cells. “Acute” means the disease advances quickly, and patients usually receive treatment immediately following a diagnosis.
Chronic lymphocytic leukemia (CLL)
A cancer of the lymphocytes, different from ALL in that the lymphocytes mature but grow abnormally, building up in the body’s blood, bone marrow, spleen, and lymph nodes. Over time the abnormal cells crowd out the healthy cells, causing problems and requiring treatment. In some people with CLL, the buildup happens slowly, so treatment may not be required for many years; in others, treatment is needed much sooner.
Acute myeloid leukemia (AML)
A cancer affecting neutrophils, a type of white blood cells. In people with AML, the body produces large numbers of immature neutrophils, called myeloblasts. The myeloblasts crowd out healthy blood cells, causing health problems.
Chronic myeloid leukemia (CML)
A cancer of the blood-producing cells in the bone marrow. Patients with CML produce too many white blood cells. They often also produce too many platelets and not enough red blood cells.
Germ cell tumors are tumors that begin in cells that, in a developing fetus, become sperm or egg cells. Because of the way a baby develops in the womb, these kinds of tumors are found in the ovaries and testes, and can also be found in other parts of the body, such as the abdomen, chest, or brain, although this is not as common.
Ovarian cancer occurs in the ovaries, the part of a woman’s reproductive system that produces eggs. With a germ cell tumor, ovarian cancer develops in the egg-producing cells of the ovary. This cancer is rare in the general population, but occurs most often in women aged 10 to 29.
Testicular cancer is cancer of the testicle, the part of a man’s reproductive system that produces sperm and sex hormones. Most testicular cancers are germ cell tumors that begin in the sperm-producing cells. Testicular cancer is most common among young men.
Melanoma is a type of skin cancer that forms in melanocytes, the color-producing cells in the skin. Melanoma often forms from or near a mole, but it can form from normal skin as well. Sun exposure increases a person’s risk for melanoma.
The term sarcoma refers to a solid tumor that forms in the muscle, fat, cartilage, or bone. A sarcoma can occur almost anywhere in the body. Sarcomas are very rare in older adults, but account for 15% of cancers in children.
Breast cancer forms in the tissue of the breast. Most breast cancers occur in the milk ducts, tubes that carry milk to the nipple when a woman is breastfeeding; these cancers are called ductal carcinomas. Other times, cancer forms in the lobules of the breast, the glands that produce milk; these cancers are called lobular carcinomas. In the United States, breast cancer is the second-most common cancer diagnosed in women after skin cancer.
Breast Cancer Resources
Cervical cancer is cancer that forms in the cervix, the lower, narrow part of a woman’s uterus. Cervical cancer is often slow-growing and is almost always caused by a Human Papilloma Virus (HPV) infection. HPV is a preventable sexually-transmitted disease.
Cervical Cancer Resources
Liver cancer forms in the liver, a large internal organ that helps digest food by storing nutrients and regulating blood sugar levels. The liver maintains the body by filtering blood and removing harmful waste from the body.
Liver Cancer Resources
Thyroid cancer begins in the thyroid gland, which is located at the bottom of the throat. The thyroid gland helps to regulate hormone levels in the body and controls a person’s metabolism. A tumor on the thyroid is usually felt as a lump in the base of the neck.
The two most common types of thyroid cancer are papillary thyroid cancer and follicular thyroid cancer, which account for 80% to 90% of all thyroid cancers and are usually curable.
Thyroid Cancer Resources
Colorectal cancer occurs in the lining of the colon (the largest part of the long intestine) and the rectum (the lowest part of the long intestine). Colon cancer is usually slow-growing, except for some cases where the disease is hereditary and develops much more quickly.
Colorectal Cancer Resources
A variety of methods are used to treat cancers, depending on the type of cancer and the size and location of the cancer. Often more than one treatment is used. The most common treatments are surgery, chemotherapy, and radiation.
Surgery is an operation to find and remove the tumor. Common side effects of surgery include discomfort and/or pain. Talk to your doctor about surgical pain; pain can be managed with over-the-counter or prescription medications, and if a particular medication doesn’t work, there are many others available.
Scars can be treated with creams or vitamin E oil to diminish their appearance and rigidity; if scarring interferes with movement, physical therapy may be helpful. Ask your doctor for recommendations.
Surgical side effects will depend on how extensive the surgery is, where in the body the tumor is located, and what kind of techniques were needed to do the surgery. Talk to your doctor before any surgery so you have a good idea of what to expect.
Chemotherapy is the use of drugs to kill cancer cells. The type of drug used will depend on the cancer.
Common side effects of chemotherapy include nausea and vomiting, hair loss, and fatigue. As with pain medications, there are many anti-nausea medications available. Many patients use a combination of medications to manage their nausea. If you experience nausea, ask your doctor or nurse for recommendations on other medications you could try.
Hair loss means different things to different people, and can be dealt with in various ways. Free or low-cost wigs are available for cancer survivors in many places; ask your nurse or patient navigator for suggestions. Other options for covering hair loss include scarves, hats, and drawing eyes on the back of your head with permanent marker.
Fatigue can make even the smallest task a challenge. Enlist friends or relatives to help with daily chores. They will appreciate having a way to help. Lotsa Helping Hands is a website that makes organizing helpers easier.
You find may your fatigue is better at certain times of day, or at different points in your treatment cycle; try to schedule activities accordingly. Moderate exercise can actually help reduce fatigue and has other benefits as well.
Through our Helping Others Fight program, UCF provides local services like transportation, household chores, and general cleaning to assist individuals who are undergoing chemotherapy and families who are affected by this treatment. If you would benefit from the help of one or more of our Helping Others Fight volunteers, please contact your UCF Patient Navigator: (410) 964-020 ext. 113. If you are a social worker or nurse Navigator seeking services for your patient, please contact Christina Miller, Senior Manager, Patient Navigation at firstname.lastname@example.org or call (410) 964-0202 ext.106 for a copy of our intake form!
Radiation is the use of high-energy X-rays to kill cancer cells.
Side effects of radiation depend on the site and intensity of the radiation. They commonly include nausea and loss of appetite, fatigue, and skin irritation at the radiation site.
To help maintain a healthy weight during treatments that affect your appetite, try eating small meals or snacks frequently throughout the day. Aim for calorie-dense food, such as cheese and eggs, and experiment to find flavors that taste right to you.
Unfortunately, multiple cancer treatments have the side effect of fatigue. See tips for managing that challenge above.
Many people experience “sunburned” skin as a result of radiation treatments. Ask your doctor for topical cream suggestions, and avoid exposing your skin to sunlight during and after treatment.
The National Cancer Institute has a good introductory guide to coping with the side effects of cancer treatments. It can be helpful to ask others who are going through the same treatments which strategies they have used to deal with side effects, although any course of action should be checked with your doctor first — including vitamin supplements or exercise routines.
Cancer and Exercise
There is mounting research showing exercise helps with the side effects of treatment and improves a patient’s tolerance for said treatment. Other benefits of exercise for people during and following cancer treatment include increased energy levels, reduced risk of infection, stimulation to the immune system, and increased confidence.