Because teen and young adult (TYA) oncology patients around the country often don’t have the same access to cancer care and treatments that adult patients do for a number of reasons, Duke is focused on expanding offerings that have been helpful in adult patients—including access to clinical trials—to better serve this population.
Lars M. Wagner, MD, chief of the Division of Pediatric Hematology-Oncology, says one of the major reasons this population is often left behind is that patients are either not included in the clinical trials process or are not as likely to be engaged in them. “TYA patients can fall in an awkward gap between pediatric and adult practices, and historically have had very low engagement in clinical trials for a variety of reasons. Creating strategies to open and recruit to age-appropriate clinical trials is critical to improving their care,” he says.
Age-Specific Expertise Across Departments
To address this gap for TYA patients, Duke is working across departments to enable more patients to participate in clinical research and developing a hospital-wide young adult oncology service dedicated to providing the same level of comprehensive, supportive care to patients, whether they're seen on the pediatrics or adult side.
“We have made intentional efforts to create seamless integration, expand our services, and provide age-specific expertise across the TYA spectrum,” which at Duke is ages 15 to 29, Wagner says. Recent funding has enabled the hiring of a patient navigator and coordinator for the program, who will facilitate the scheduling process for patients and ensure that they receive equal and appropriate access to support services.
Wagner notes that issues with finances, transportation, compliance, and fertility preservation can be problems for any age range but are particularly important to address in the TYA population. Working to resolve these types of issues may also encourage patients to participate in clinical trials, he adds.
Maximizing TYA Clinical Trial Opportunities
Pediatric cancer is relatively rare; in the U.S., there are roughly 15,000 new cases per year, which is only about 1% to 2% of all cancers, Wagner says. “Cure rates for diseases within the TYA population have also been fairly stagnant, and because incidence of cancer increases with age, a larger portion of our patients tend to be teenage patients rather than younger children,” Wagner says.
Wagner’s research focus is on the development of new therapies for pediatric and young adult patients with sarcoma, for which there are multiple clinical trials spanning the TYA population gap. “We're trying to maximize the amount of clinical research that patients can be given the opportunity to participate in,” Wagner says. “We're never going to have better outcomes unless we have more patients engaging in clinical research, and we can affect the pace of that by getting more patients involved. It is only through clinical trials that we can further our understanding and hopefully continue to improve the outcomes of our patients.”
Daniel Landi, MD, a Duke pediatric neuro-oncologist who specializes in brain and spinal cord tumors, is leading several clinical trials with inclusion criteria based on diagnosis rather than age. “Our trials, treatments, and approaches are predicated on the disease, which often spans the pediatric and young adult age range,” he says. “As we screen patients and consider eligibility, the genetic similarities between the tumors will be a lot more similar between a 12-year-old and a 30-year-old than they would be between a 30-year-old and a 70-year-old. Our particular savvy at Duke is in discerning and understanding what clinical approach is best suited.”
With the support of the Department of Pediatrics and the Preston Robert Tisch Brain Tumor Center, Landi has been working to extend promising, cutting-edge immunotherapy trials to TYA patients that began on the adult side, including cancer-directed vaccines and an oncolytic poliovirus. “Our patients have access to the most promising trials in pediatric and adult care focused on the disease, not their age, because their disease is in many cases different among very young kids or adults in their late 70s and 80s.”
Having a unified space strengthens enrollment and allows Duke clinicians like Wagner and Landi to focus on breaking down the artificial divide between TYA and adult patient care and clinical trial access.
“This research and regulatory data support team at Duke allows for seamless acceptance of patients into these trials based on diagnosis and pertinent clinical history instead of age or referring doctor,” Landi says. “That’s really helpful because you can draw from both spaces, meaning that kids and adults with a certain brain tumor diagnosis can participate in immunotherapy trials under one roof, under one study, under the same care team, which then allows you to run larger trials with greater participation and—in some cases—greater opportunities for patients.”