Instilling Hope: A Comprehensive Model of Cancer Care for Younger Adults

In the past decade, the incidence of numerous cancer types has increased, particularly among younger adults under age 50.¹ For younger adults, many of whom are primary breadwinners of their households or in the height of their educational or professional careers, a cancer diagnosis at this life stage can be unexpected and jarring.

In response to this alarming trend, cancer centers are mobilizing providers and resources to meet the multifaceted needs of this patient population, adopting a care model that prioritizes emotional and psychosocial well-being alongside intensive, targeted clinical treatment.

In an interview with Targeted Oncology, Shane Dormady, MD, PhD, medical director of El Camino Health Cancer Center, describes the unique needs and challenges of younger adults, outlines El Camino Health’s comprehensive care strategy, and offers insights and considerations for treating and interacting with this patient population.

Targeted Oncology: How does cancer care and the priorities of care differ for younger adults vs older adults?

Shane Dormady, MD, PhD: The priority of care really focuses on their emotional state and well-being. Young patients, when they're diagnosed with cancer, are typically not thinking about their mortality. They're thinking about their day-to-day schooling, their job, very often their children and their families, and so the diagnosis of cancer at this young age turns their world upside down.

I think what differs is that you really need to pay attention to the need for hope, the need to instill hope in the patient, and the principle of keeping their mind, body, and emotions all intertwined. Moving in the right direction becomes critical, because it's very, very easy for younger patients become despondent, lose hope, and be discouraged. But you have to make sure you focus on emphasizing their reasons to live, focusing on their children and why they're doing the treatment, and then working with a team of professionals within your cancer center, such as [an] oncology-certified psychologist, to really engage patients like this and help them manage the fears and anxieties that go along with their diagnosis.

What is the importance of a multidisciplinary care team? Can you describe the roles of each person involved and the process of integrating nonmedical support into the standard oncology workflow?

I think [“multidisciplinary approach”] is too faceted—I think of the different specialties of doctors that are involved in cancer care. We present all of our new cancer cases, young and old alike, at our weekly multidisciplinary tumor board conference, so we have direct, real-time input from multiple surgeons, pathologists, radiologists, the radiation oncologist, and then the medical oncologist, all forming a consensus plan for every case that's diagnosed here at El Camino Health.

In terms of the day-to-day management of the patient, my team consists of me, [as well as] a nurse practitioner who works closely with me, who can see patients independently and typically be even more accessible than I am … but the nurse practitioner’s daily schedule is sometimes lighter. They can field calls from the patients. They can see sick calls when the patients become acutely ill or have [adverse] effects from chemotherapy, and they are an invaluable resource to the team.

Then, [there are] nurse navigators who see the patients with you, help arrange [and schedule] appointments, and move the patients through the entire process. As we all know, there are inefficiencies with certain aspects of medical care, and if a patient is trying to arrange a test, scan, or referral to another doctor, sometimes that leads to extended wait times on the phone, frustrations, and getting the runaround. The nurse navigator cuts through [and] takes care of that for the patient so that they can focus all of their energy on healing and defeating cancer.

Then, [there are] medical assistants who room the patients and take the patient's history, record their medications, and so forth. We have the oncology psychologist, and then, a critical piece of the equation, an oncology-certified dietitian who helps us manage through all the nutritional aspects of cancer care. Depending on the treatment, there are certain things to avoid eating [or] focus on eating, so [they] also [are] an invaluable resource for the patients.

Finally, we have a palliative care team that helps manage the symptoms of the patients, like nausea, pain, shortness of breath, and if a patient is unfortunately losing their battle against the cancer, sometimes we have to enroll them in hospice services. The palliative care team helps with that as well. So, we have a fully rounded and comprehensive team to take care of our patients.

What steps are taken to ensure seamless coordination of care across these different providers?

Well, the good news is the providers at El Camino Health all share the same electronic medical record [EMR], so whether it's tests that are ordered or communications with the patients or offices, it's with other doctors we are privy to and can see all of those notes [and] results. So, I think the [EMR] is the thing that most promotes seamless communication and care of the patients, even when they get tests done at academic centers or other health care organizations. You can still see those in the electronic health record as well. That's really the key thing—focusing on your own documentation when you are entering notes into the system to make it clear to everyone who's reading them, what you did on any given day or visit.

With a comprehensive approach, how do you create a balance between intensive treatment interventions and a patient's desire for a good quality of life while also accounting for potential barriers during treatment?

Well, that is a perfect segue to one other critical member of the team. We also have multiple licensed social workers who take care of our patients and help them through all of those types of situations, helping them to figure out what might be the best thing, whether that's long-term disability, leave of absence, short-term disability, [and] all the papers and forms that need to be submitted. … So, that again relieves another source of major stress on the patient, to make sure that they have income coming in while they are going through their treatment.

But after that, I think if we're talking about patients under the age of 55 or 50—younger patients—these patients are typically very physically fit and have very few additional medical problems. For them, we have to understand that there will be some shock.

What I critically stress to all patients of every age is, thinking about cancer as a stage 4, doom and gloom, metastatic prognosis [is] obsolete, archaic thinking in this day and age. I try to stress that even metastatic cancer is just a medical condition, just like high blood pressure or diabetes, and as long as we use the DNA of the cancer cells, molecular profiling, [and] immunotherapies to devise the best medical regimen for the cancer, we can keep those patients—even the patients who have metastatic disease—in remission for years and sometimes decades. And so, I tell them, there is always hope. We are really just in a chess match with the cancer. When the cancer moves this way, we have to immediately establish a counter move in the other direction, and we play that game indefinitely.

Could you share any anecdotes about treating younger patients and the impact of seeing El Camino's cancer care in action? How did your intervention strategy change their treatment trajectory?

What I can think of is a young man diagnosed with testicular cancer. He was in his 30s, an extremely complicated case where he presented with a large mass in his chest, which, oddly, is one way that testicular cancer can present. He had to have radiation to his chest, then multi-agent chemotherapy, then surgery to remove certain cancer deposits in his lungs and liver. Then, when we had those specimens from the lungs and liver, we did something very interesting. We basically analyzed those tumor cells for different gene mutations within them, and we found that there was a medication we could use to directly target his cancer like a guided missile.

After the surgery, we placed him on that medication, [and] he immediately went into complete remission and has remained that way for the last 20 years. He's traveling the world, playing basketball. I always try to remember that story and share it with other young patients to say, “This can be you.” If we went by archaic, older thinking, we would have said, “Oh, I'm sorry, sir, your prognosis is poor. We can't do much to help you,” but with new profiling, DNA typing, genetics, [and] immunotherapy, this is a patient who's now basically cured with stage 4 disease.

What would you say are the most important takeaways regarding adapting care and interactions to this patient group?

I would say to—and I know it's hard—do our best to resist the temptation to become cynical or jaded. In the field of oncology, you have to deliver a lot of bad news. You deal with a lot of shifting, swaying, and spiking emotions. It's like a roller coaster sometimes. I would tell my colleagues, especially with our younger patients, never, never subscribe to that cynicism, and always take the active, aggressive fight to the cancer approach. Think about the standard of care to offer all of those young patients and then use molecular profiling to go one step beyond the standard of care—add a special ingredient to achieve unsurpassed outcomes for these young patients.

REFERENCE:

1. Shiels MS, Haque AT, Berrington A, et al. Trends in Cancer Incidence and Mortality Rates in Early-Onset and Older-Onset Age Groups in the United States, 2010–2019. Cancer Discov. 2025;15(7):1363–1376. doi:https://doi.org/10.1158/2159-8290.cd-24-1678