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

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