Why you should care
Where you’re treated for cancer matters more than we realize.
At 22, Melissa Blitgen’s life was upended by blood cancer. Being an adult at a regular hospital meant she would receive the standard adult regimen. But after her first month in remission, her doctor realized the treatment she was getting might not be the best. “My oncologist had gone to a conference and decided he wanted to switch treatment plans” after he learned that pediatric regimens had better outcomes for her type of leukemia, she says.
Blitgen is celebrating 10 years of being cancer-free, but her oncologist could have gone a step farther and sent her to a pediatric unit instead of keeping her in the adult oncology unit. According to a new study in the journal Blood Advances, analyzing 1,473 acute lymphocytic leukemia (ALL) patients ages 15 to 39:
Young adult leukemia patients treated in pediatric settings are twice as likely to survive.
Previous studies have shown that pediatric regimens result in better outcomes for young adult patients, a group usually defined as 15 to 39 years old. “The first reports were in the early 2000s, and outside the U.S., there was a pretty rapid shift” to the pediatric regimen, says Dr. Lori Muffly, clinical assistant professor of medicine at Stanford and lead author of the new study.
In the U.S., the shift was slower. In the late 2000s, when Blitgen first went in for treatment, she received an adult regimen called Hyper-CVAD. Like other adult regimens, it’s fairly straightforward and high on drugs called anthracyclines, which cause damage to rapidly dividing cells, both good and bad. While adult regimens sometimes can be used for a variety of cancers, pediatric regimens are more specific and complex, and rely more on high-dose steroids, an enzyme called asparaginase and spinal taps.
This new study suggests that the pediatric setting is also important for the patient. Muffly believes this might have to do with the complexity of protocols. She makes a cooking analogy: “If you have a really complicated recipe, it’s better if you have experience with the recipe than if you’re doing it your first time.” And if patients are treated in a pediatric cancer center — no matter how old they are — doctors opt for the pediatric regimen, because that’s what they are familiar with. “To me the overwhelming take-home is that this population really needs to be cared for in centers that have expertise,” says Muffly.
I’m glad I was treated as a child. Hearing it had better outcomes gave me the hope I needed.
Melissa Blitgen, former cancer patient
The study recommends that patients at least up to age 25 be treated in a pediatric setting, and using the pediatric protocol for patients up to age 39 shouldn’t be that foreign an idea; Muffly notes that some major cancer centers use the strategy for patients as old as 55.
“Adolescents and young adults with cancer are burdened with challenges unique to their developmental stage and age group,” adds Christina Miller, director of AYA patient navigation at the Ulman Cancer Center for Young Adults, in Baltimore. For Blitgen, being the youngest person in the waiting room was difficult. She felt extremely out of place, she says.
But moving a young adult to a pediatric unit has its drawbacks too. Paige McCoy, who was also diagnosed with ALL, chose to be treated in an adult center. At 28, she was married, and her husband stayed with her while she was in the hospital. She thinks it was emotionally easier to be with adults than children, and patients’ feelings can be really important too. As for Blitgen, “I’m glad I was treated as a child,” she says. “Hearing it had better outcomes gave me the hope I needed.”