Paola, an 18-year-old girl, works, gets her driver’s license and is socializing again. She tries to rebuild her life after recovering from Ewing’s sarcoma. She is one of the patients at the specific oncology clinic in Vall d’Hebron dedicated to tumors typical of adolescents and young adults, the only one of these characteristics in Spain.
Oncology care for young patients, between 14-15 and 25 years of age, is highly developed in the United Kingdom and in a growth phase in countries such as France or Italy. Here, there are hardly any examples of this model, and none like the one in Vall d’Hebron.
“Towards the year 2000 in Great Britain they realized, through the computation of all the registries of the pathology, that the population group in which cancer survival had least improved in the two previous decades was that of the young” , explains Paula Pérez, Pediatric Oncology assistant at the Barcelona hospital. Thus, specific oncology units for young people were designed and started up. They have already created 28.
Along these lines, Vall d’Hebron has integrated the Pediatric Oncology and Medical Oncology (adult) services to care for the aforementioned segment of the population (15 to 25) but also cases of adults with pediatric tumors and, conversely, of adolescents with adult-like cancers.
“It is about age not being a limit to receive the best care,” says Dr. Pérez. In Spain, it was established in 2018 that all children under 18 years of age should be cared for in pediatric oncology units, although it is estimated that 50% of patients between 15 and 18 years of age end up in adult units.
The new model seeks not to treat by age, but by therapeutic needs. Depending on the biology of the tumor and its location, with an adequate approach, adolescents and young adults present cure rates close to 80%.
At these ages, cancer generally develops more rapidly, requiring more intensive diagnosis and treatment circuits. At the same time, Paula Pérez stresses the importance of psychosocial and emotional support for patients of the age to build their identity and life itinerary.
“Aesthetic sequelae may appear, or having to readjust academic plans, and these sequelae may affect their autonomy,” explains the oncologist. The team also assesses the effect of treatments on fertility, and performs sperm reserve in boys and oocyte preservation in women.
At this time, the practice is focused on the treatment of a group of solid tumors (brain, germ cell, and bone and soft tissue sarcomas), closely related to development but which can be diagnosed well after the infant stage. “We have treated cases of adults with tumors typical of the pediatric age and vice versa, such as a 60-year-old woman with a Wilms tumor and a 48-year-old man with neuroblastoma, diseases typical of young children,” says Pérez.
Dr. Pérez considers it necessary to extend the model of the oncology consultation for adolescents and young adults in order to alleviate the existing delays in the diagnosis of this segment and to “increase awareness regarding the specific needs it presents”.
In this population group, cancer is a rare disease. Of the 14 million cases of cancer diagnosed each year in the world, 5% affect people under 25 years of age. In just over a year of operation, the Vall d’Hebron clinic has assessed 45 new patients. The majority are local and come from primary and emergency consultations. In this sense, the professionals in the unit insist that symptoms such as inexplicable weight loss or persistent pain should not be overlooked. A quarter comes from other autonomous communities. These are patients with very rare pathologies.
After a treatment with chemotherapy, surgery and a lot of recovery to recover the mobility of the arm, Paola remembers with great gratitude her time at the Vall d’Hebron clinic, which occupies some premises in the children’s hospital. “Despite the illness, I remember the happiness they have with this plant,” she says.
