13a barriers to the care of adolescents and young

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  • 1. Barriers to the Care of Adolescents and Young Adults with Cancer in the Medical Oncologist’s Office
    AnuDham MD
    Cancer Care Centers of South Texas
  • 2. One in every 168 Americans develops invasive cancer betweenage 15 to 30 years
    No specialized centers of care, transition between adult and pediatric
    Medically underserved population, “special population
  • 3. What Makes a Person Part of a “Special Population”?
    Age
    Race and ethnicity
    Gender
    Income
    Insurance status
  • 4. Health Disparities
    Unequal access to health care for segments of a population
    Inferior health outcomes
    Unequal burden
    morbidity
    quality of life
    survival
  • 5. What ELSE?
    Rural environment
    Abilities/disabilities
    Physical
    Cognitive
    Educational
    Sexual orientation
    Demographic and social characteristics that are different from the majority
  • 6. Diagnostic Delays
    Ignoring symptoms (patients), sense of invincibility
    Insurance and access to healthcare, usually no “well” visits
    Not thinking about cancer (physicians)
    “Empirical treatment”, antibiotics etc
    Impact cancer stage and hence survival
  • 7. Treatment Barriers
    Dosing intensity in cancer treatment
    Adherence to schedules and regimens (practical and psychological issues)
    Resistance to disfiguring surgery, mastectomy, colostomy, amputation, orchiectomy
    Higher use of alternative medicine, specially female
  • 8. The Self
    Practical problems in social life
    Alopecia
    Weight gain or loss
    Mucositisand dermatitis
    Bleeding, infection and contagiousness
    Susceptibility to infectionand need for isolation
    Impaired sexuality
    Pressure to stay “normal”
    Suspicion if partner staying in relationship due to guilt
  • 9. Survivorship
    More risk taking behavior
    Oligospermiaand ovarian damage
    Fertility
    Persistent anxiety, Damocles syndrome
    School, work, wages
    Family relationships
  • 10. Survivorship
    Lifelong cognitive deficit
    Disorganization
    IQ
    Poor emotional control
    Osteoporosis
    Heart disease
    Premature menopause
    Chronic pain
  • 11. Adult Oncology Office
    “ New Doctor”
    Surrounded by older adults, no peer group
    Chronological vs developmental age
    Dependency on parents
    Higher expectation of independence
    Insurance access
  • 12. Independence
    Appt making
    Med refills
    Medical history
    Healthy life style choices
    Life goals
    Stress management
    Bill paying
  • 13. Interventions
    Honesty in communicating
    Peer groups
    Encourage independence in schedules and treatment
    Foster control
    Plan transition early if pediatric cancer survivor