Leading experts from numerous disciplines, including medical oncology, obstetrics and gynecology, endocrinology and pediatrics, came together with the goal of improving cancer care for young people during the first-of-its kind University of Florida AYA Oncology and Oncofertility Conference on April 11-12.
The conference, held at the Cancer & Genetics Research Complex, highlighted innovative approaches to optimizing treatment and fertility preservation in adolescent and young adult (AYA) cancer patients and survivors.
“Our goal is to build bridges across disciplines because we all have the same goal: to improve the lives of AYA patients not only during cancer therapy, but also in survivorship,” said Leighton Elliott, M.D., director of the UF Health AYA Cancer Program and an assistant professor of medicine and pediatrics in the UF College of Medicine.
Each year, nearly 90,000 AYA patients — those between 15 and 39 years old — are diagnosed with cancer. These patients face specific developmental, mental health and social challenges associated with getting a cancer diagnosis at a time of major life transitions.
Much work remains to understand why AYA patients get more aggressive cancers, including late-stage breast cancer, colon cancer and melanoma, as well as chemotherapy-resistant Ewing sarcoma, Elliott said. In addition, AYA enrollment in clinical trials is as low as 10%, which limits the ability to tailor treatments. Gaps in research remain in part because AYA patients are sometimes grouped with older adults or children.
Last summer, a grant from Teen Cancer America allowed the UF Health AYA Cancer Program — one of four in the state — to expand clinical care and support services. UF’s multifaceted program includes a nurse navigator and social worker, as well as the powerful peer support program Streetlight, to help AYA patients navigate psychosocial challenges.
The conference, which Teen Cancer America sponsored, was the third oncofertility conference at UF, but the first to be combined with AYA oncology.
“I’m optimistic that through collaborations, we will come up with a method that ensures everyone has an opportunity to make a decision about fertility preservation,” said Alice Rhoton-Vlasak, M.D., director of the UF Health Oncofertility Program. Rhoton-Vlasak was inspired to start the conference because of the enthusiasm her father, who founded UF’s Lillian S. Wells Department of Neurosurgery in 1972, had for collaborative learning.
“I’m optimistic that through collaborations, we will come up with a method that ensures everyone has an opportunity to make a decision about fertility preservation.”
“It’s so important to think about fertility when you’re thinking about newly diagnosed cancer, and we still have a long way to go,” Rhoton-Vlasak said.
An article in The Cancer Letter this month reported on how only half of adolescents and young adults with cancer get fertility counseling before treatment.
The conference drew several national experts, including Archie Bleyer, M.D., a clinical research professor at Oregon Health & Science University and a trailblazer in AYA oncology.
Bleyer discussed how in AYA patients, cancer in the reproductive organs of both female and male patients is increasing in most countries worldwide. The only reproductive cancer that is decreasing is cervix cancer due to the effectiveness of the HPV vaccine.
Breast cancer in AYAs has had the greatest increase. In Florida, the greatest increases have been in breast and uterus cancer.
Causes of the increases in AYA cancer cases most likely include increased obesity rates and increased CT scanning and other radiation imaging in children and adolescents, Bleyer said, adding that cannabis may also be a cause and needs to be studied further.
The trends highlight the need to look at causes of infertility beyond cancer treatments. “Instead of cancer therapy infertility, we should also be concerned about reproductive organ cancer infertility,” Bleyer said.
The conference also included the perspective of an AYA patient. Amanda Brunson, now a patient advisor at Moffitt Cancer Center, shared her journey as a young adult with acute lymphoblastic leukemia, which included a bone marrow transplant. She shared the challenges of survivorship, including ongoing costs of medication and premature menopause.
Other lectures touched on fertility preservation accessibility, outcomes from cellular therapy, communication, financial toxicity and treatment adherence challenges. A panel session that included a UF Health reproductive endocrinologist and addiction medicine specialist delved into cannabis use among AYA patients. Moderated by UF Health nurse practitioner Lauren Staley, ARNP, the session underscored the need for a personalized, holistic approach to patient care.
Detailed education was provided on available fertility techniques. Experts also discussed recently approved techniques like ovarian tissue freezing, highlighting the recent successful use of this technique. Gregory Christman, M.D., a reproductive endocrinologist at the University of Michigan, provided updates on some of the newest fertility preservation techniques being studied, while Jennifer Levine, M.D., from Children’s National Hospital outlined a multisite clinical trial studying GnRH agonists as a tool to preserve fertility in patients receiving cancer therapy.
Awareness of AYA oncology is growing, with the National Comprehensive Cancer Network recently issuing guidelines dedicated to AYA oncology. A global AYA Congress is held annually, and a scientific journal is dedicated to AYA issues. But more work is needed, Elliott said.
“I hope this is another first step in increasing awareness of what AYA is and how to treat AYA patients with cancer who require specialized care,” he said. “We need more understanding among adult oncologists and other health care professionals that people who are in their 20s can unfortunately get cancer.”
Support for the conference also came from the Climb for Cancer Foundation, the UF Departments of Obstetrics and Gynecology, Pediatrics and Medicine, the Marshal Fisher Fund, and the UF Health Cancer Center, where Elliott and Rhoton-Vlasak are members.
