Organization Background
St. John Health, a group of nine hospitals anchored by St. John Hospital & Medical Center (SJHMC) on Detroit’s East side, offers comprehensive cancer care with a program approved by the American College of Surgeons Commission on Cancer. The freestanding Van Elslander Cancer Center (VECC) at SJHMC offers complete outpatient services for cancer patients, with adjacent clinics for adults and children, treatment rooms and diagnostics (with hospital-based CT, PET and MRI). We also provide a unique set of holistic services in our Valade Healing Arts Center (yoga, massage therapy, art therapy, reflexology and more) while our courtyard labyrinth sets the tone for spiritual renewal walks and meditation.
St. John Health has demonstrated a commitment to oncology and developed an organized network to provide the highest quality clinical services across its health system. SJHMC has identified a vital need to improve and coordinate the care and support services of cancer patients aged 15 to 39. As such, it is developing the Adolescent and Young Adult Oncology Program (AYA) as a partnership between pediatric and adult medical oncology services, with full support of the St. John Health Oncology Clinical Network. The program will provide care to this age group, conduct clinical research, and offer support and health education to adolescents and young adults with cancer.
At present, many primary care physicians, pediatricians and adult oncologists are unaware of the clinical trials available to treat these patients. They would welcome a resource that would match a patient’s disease and particular circumstances (age, overall health, activity level, family support, goals, etc.) to the appropriate clinical trial.
St. John Health System treats 5,000 cancer patients annually; with an estimated 200 young adults in this age group (15 to 39). Many of these patients could be referred for treatment to the AYA program.
Need and Significance
Nationally, nearly 90 percent of the patients seen in pediatric settings are younger than 15 years old; likewise more than 90 percent of all patients seen by medical oncologists or at adult hospitals are older than 40. Yet each year in the U. S., 70,000 individuals between the ages of 15 and 39 are diagnosed with cancer. Because of the gap in age-appropriate clinics, these patients often miss out on clinical trials and support services that meet their unique needs and can help them achieve superior outcomes.
While younger children and older adults with cancer have shown a steady 1.5 percent annual improvement in five-year survival rates, AYA patients have had no change in survival rates in 20 years.
The top five cancer diagnoses in this age group are: lymphoma, leukemia, soft tissue sarcomas, germ cell tumors, and brain tumors. Prognosis is typically poor because patients aren’t enrolled in clinical trials, do not receive adequate support, and are not offered alternative treatments with proven effectiveness. Cancer is more complex in this age group. Some adults get cancers that typically affect children and vice versa. When cancer occurs in atypical age groups, it may behave differently due in part to the patient’s age and biology.
The rarity of cancer among this age group presents a unique challenge to the medical community. This group of patients needs ongoing psychosocial and medical support to help them cope with any of the following stages of life: completing their education, doing favorite activities (e.g. Lance Armstrong continues to bike as a cancer survivor), getting married and starting families (infertility/fertility counseling), and working.
A case in point is Autumn, who was 21 years old when she was diagnosed with acute lymphoblastic leukemia and told by her (non-AYA) oncologist that the disease could be treated but would recur and her chances of survival were poor. She was referred to the AYA oncologists and received optimal chemotherapy that enabled her not only to survive, but also to thrive. That is the success we want to replicate through this program.
