Cancer in Young Adults Health Radio July 11, 2007 Brandon Hayes-Lattin,M.D. Todd Smaka, M.D. Introduction

Transcription

1 Cancer in Young Adults Health Radio July 11, 2007 Brandon Hayes-Lattin,M.D. Todd Smaka, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. Introduction Good morning if you're on the West Coast like me and sunny and hot. It's going to be like a hundred degrees in Seattle today. Oh, my. I've been out there watering the plants, I can tell you. Or good afternoon if you're in the East or Midwest and good evening or good morning or whatever it may be. Wherever you up are with us around the world on the internet, welcome back to Patient Power. I'm Andrew Schorr. This is the only program on radio or online where day after day we talk in depth about important health issues for you, your family, your friends and neighbors. And then all the information is there for you whenever you want it online at either healthradio.net or my website, patientpower.info. Now on patientpower.info there are well over 300 hours of programs with leading experts inspiring patients. It's all there for you. And then as people travel this summer many people are downloading information as podcasts. There was a lady with cancer multiple myeloma and she was online with me today, now, how do I do that again? But instructions are all there, so it's Patient Power to go, but it's important information. And I think what's important is there's so much information on the internet and in newspapers, little snips of things, but here we connect you with really credible experts. But also we connect you with the story behind the experts, and that's what I'd like to get to now. Our topic today is cancer in young adults. And, you know, it happens more often than you would realize. There are about 65,000 young adults in their 20s and 30s in the US that are diagnosed with cancer every year, and also you may not know that cancer is the leading disease killer among people 20 to 39. So this is not at all a trivial diagnosis. So there you are in your prime of life, and then you get a diagnosis that just comes out of left field. And yes, it's true, most often cancer, where your own cells have gone haywire, is a diagnosis that comes as you age. But it also affects people who are younger, and sometimes with the symptoms they have it's not picked up, depending upon the cancer, right away because, wow, this is a young person. Their hip hurts? Couldn't be lymphoma. Must be a sports injury, you know. They got little lump here? Couldn't be sarcoma must be just something else. But anyway when it does turn out to the cancer it's a terrifying diagnosis. Well, I want you to meet a physician who's devoted to helping people with cancer and has 1

2 a particular interest in helping young adults. How come? Because it happened to him. Dr. Brandon Hayes-Lattin is an assistant professor in the department of medicine. He's a hematologist oncologist at Oregon Health and Science University. And so he is a man who as he was going through his medical training, guess what? Diagnosis with testicular cancer. Yes, that's the diagnosis that Lance Armstrong had, and guess what? They shared the same physician. And happily Dr. Brandon Hayes-Lattin is doing well, but he has now then devoted himself to helping others. And, not surprisingly, guess what? He is very involved with the Lance Armstrong Foundation and he has been on the organizing committee in their effort to help young adults with cancer. So, Dr. Hayes-Lattin, thank you for joining us from Portland, Oregon. I want to get into more of your story. When that diagnosis happened with testicular cancer, how old were you, where were you with your medical training, and it must have come out of left field, I'm sure. Yeah, it really did. First, Andrew, thanks a lot for inviting me to join your program. I'm really excited to get a chance to talk about this important issue. For me, my own cancer started about 11 months after finishing medical school. I was 28 years old. I had just moved to Portland to start my internship. It was actually the week of my board exams when I incidentally discovered a mass in a testicle, and I actually knew at the time that in a young man who had a painless mass in the testicle it was sort of testicular cancer until proven otherwise. I was obviously still interested in the biology of these tumors and instantly went to my medical resources to look it up and found that the prognosis was good, but I was really struck by how much it affected my life both right then and for the next years to come as a survivor, even with a good-prognosis cancer. Right. It's life changing, we all know it, and so you're one of the you know, I used to think, and I've written about this on my blog that doctors never get sick, because when I was a little kid I was always sick, the doctor came in, they made house calls back then, came in with a lot of energy and a lot of guidance, but of course we're all human. So this must really give you a special connection with your patients and also through the Young Adult Alliance of the Lance Armstrong Foundation because you've lived it and continue to live on as a survivor. Isolation for Young Adults with Cancer Yeah. One of the things that really struck me was how isolating it can be to be a younger person with cancer. When I was in a waiting room for a CAT scan or to visit a physician in a cancer clinic oftentimes I was the youngest one around. And I actually sought outside sources just to find other young adults going through the same sort of experience as I was. That's part of what connected me to the Lance Armstrong Foundation and lots of other groups of young adults who have become advocates in terms of their own cancer 2

3 experience. Later on we're going to meet in the program someone who is at your same institution who is also,who is in his residency, I believe, and has been diagnosed with cancer. So kind of ironic. He's yet another someone studying medicine, and they're a young adult with cancer, and now we see the statistics, we know it's not all that uncommon. What are the efforts that the Lance Armstrong Foundation is doing to help young adults with cancer? Issues for Young Adults with Cancer So the issues of young adults with cancer has really been a major focus of Lance Armstrong Foundation, and they've started a program called the Live Strong Young Adult Alliance. The Young Adult Alliance is really a coalition of various organizations, both professional societies and medical organizations as well as cancer advocacy groups, all sharing a passion to improve outcomes for young adults diagnosed with cancer. The Lance Armstrong Foundation has worked very closely with the National Cancer Institute in this effort and defined this program as serving young adults who were diagnosed with cancer between the ages of 15 and 40, based largely on some of the statistics that you already mentioned, that there's about 65 to 75 thousand cases of cancer diagnosed in this age range in the United States a year, and it's the leading disease killer. There is no other disease that kills more young adults than cancer. So it has to do with focusing on survivorship rates, and we can talk more about that later. It has to do with age appropriate supportive care and all the other issues that go into having a cancer diagnosis. Okay. Well, we will get into this in depth and, again, meet that other fellow in medicine who is dealing with cancer himself. We're discussing cancer in young adults. We're discussing it in depth. We're visiting with Dr. Brandon Hayes-Lattin from Oregon Health and Science Cancer Institute in Portland, Oregon, who is a physician, devoted to cancer patients but has lived with cancer himself. We'll be right back with more of Patient Power. As the man said, give us a call. We're discussing cancer in young adults, and our guest right now is Dr. Brandon Hayes-Lattin, a physician, a hematologist oncologist devoted to helping people with cancer and special interest in helping young adults with cancer. How come? He's lived it himself with testicular cancer, as he was a med student. 3

4 So, Doctor, help us understand then how it happens. First of all, was your cancer picked up quickly? Because I know often in young adults, first of all, somebody in their 20s or 30s is not at all expecting that ache or pain or that lump to be cancer or that fatigue, whatever it may be, a sign that have because often it could be so many other things that would be more likely. And their physician isn't expecting that either. And I'll just go back to that story I was alluding to earlier. Young women who had been the honored patient with the Light the Night Walk with the Leukemia and Lymphoma Society in Seattle last year, I had her on my radio show, and it's in our archives on patientpower.info, as we earlier discussed cancer in young adults. And so she went for months and months. She had pain in her hip and initially went it her primary care doctor, oh, you probably just worked out too hard. You know, I'm tired. She just graduated from the University of Washington, where I think you were educate went as well, and she was just tired, had hip pain, etc. Oh, it must be sports related. And she went back, and finally when she couldn't walk she demanded to have further exam and it showed that her bone marrow was very and she had a biopsy and everything, that she had lymphoma and then went through very aggressive treatment for that. So could it have made a difference, earlier diagnosis, or could she have planned what, lied ahead or just known what was going on. But how often does that happen, that neither the patient nor the physician say its cancer, even suspect it? Delay in Diagnosis for Young Adult Oncology It happens all the time. It's way too common, and it's one of the major problems in adolescent and young adult oncology is this delay of diagnosis. There have been objective studies proving this. There's been studies within pediatric consortiums that look at the average time from onset of symptoms to diagnosis in younger kids versus older adolescents and found that for every solid tumor with the exception of Hodgkin's disease there was a longer delay from symptom to diagnosis in the adolescents than in the younger kids. The flip side too is true. Compared to older adults it's not uncommon at all for someone with for instance a sarcoma and bone pain to go months and months before a diagnosis is made. And there's probably multiple reasons for that. One is obviously that the patient themselves doesn't consider cancer, that we described already while it is the leading disease killer it is only about 65- to 70,000 cases in the United States per year. And these are often young, healthy, active patients who may very well mistake an ache or a pain for a sports injury or something like that or not even consider cancer in the first place. If they do see a physician they may not think to give relevant information like family history of cancer or some exposure history. But the flip side is that providers also don't consider cancer. It's not uncommon at all for someone to go multiple provider visits before the appropriate imaging study or the appropriate historical question is asked that leads down the path to a diagnosis of cancer. 4

5 Yeah, that was the story with this young woman too. And then our producer, her brother was diagnosed with sarcoma and the same thing. I think it took a little while, although he did get to a cancer center pretty quickly because we do this all the time. She said, You're going there, and he lives in Houston so he went to M. D. Anderson there, and he got the workup. And he's actually involved in a clinical trial. So what about that then? Where are we now when somebody gets,first of all, first question is we usually say in cancer earlier detection leads to a better outcome. So we already suggested that maybe there's a delay often for adolescents and younger adults in getting a diagnosis. Is that affecting the outcome, do you think? Yeah. We definitely think so, and in fact I can describe a lot of data that shows that while the absolute survival rates for young adults is pretty good in terms of cancer survivor rates it's been static since the mid 70s. We've seen no major improvement in cancer survivor rates for young adults since the mid 1970s, and that's a dramatic contrast in both younger kids and older adults, who've both shown very substantial improvements in five-year cancer survival rates. So we think that there's multiple reasons for that. One of them is certainly this issue of delay in diagnosis. Some of the other sort of health services factors that go into that also have to do with just the lack of having a primary care provider or a regular physician that young adults go to. Or insurance. Exactly. This is the population that across the board has the highest rates of uninsured. It's approximately 30 to 35 percent in the latest SEER survey of 18- to 34-year-olds do not have any health insurance. So I think there's lots of sort of access and diagnosis issues that are leading to our inability to change the survivorship rate. Oh, my goodness. By the way, I'll mention, it's going to be controversial, but I wrote a blog yesterday that's on patientpower.info about the extraordinary care that we give our soldiers in Iraq, and there's a whole documentary on 60 Minutes last Sunday, and I think that's very appropriate. But the thing that follows is where and here we're talking about other people the same age where they have a catastrophe in their life, and they're facing a "battle," and we don't have those resources that can be brought to bear as well, and again we talk about people without insurance etc. So we've got to fix that somehow. But that's on the blog on Patient Power. I'd love your thoughts on that, folks. 5

6 And, Doctor, so here we are, though. Where are we now in trying to understand these cancers better. You mentioned family history. Is family history a big factor in some of these, that that's why this younger person is diagnosed with cancer versus other folks that don't have that diagnosis? Impact of Family History Well, it turns out that family history can be important in tumors, particularly patients who are younger but tend to get older adult types of cancer. So a younger person with colon cancer, a younger person with ovarian or breast cancer, that's often sort of a harbinger of a family syndrome. But across the board there are other sort of unique cancer types that affect young adults for which there's probably not a real strong hereditary component. And interestingly enough there's probably not as strong an environmental component either. So in other words we classically think of a long history of smoking being associated with lung cancer, sort of these long-term environmental exposures causing cancer, but oftentimes the cancers that happen in young adults are not that way. So there's a lot of the basic biology of these cancer subsets that we don't understand. Young adults tend to get more hematologic cancers like leukemias and lymphomas. They tend to get more genital cancers like either testicular cancer or cancers to the female genital system. Brain tumors and sarcomas and melanomas are common in young adults, and these compared to cancers in older adults are relatively rare. There's probably unique biology there. Well, we're going to discuss this a lot more. We're also going to meet a resident in anesthesiology at your same institution, Oregon Health and Science University Cancer Institute, who is dealing with cancer now, I guess, or has, and we're going to find out more about that as we continue on Patient Power and discuss cancer in young adults. Stay with us. Welcome back to Patient Power. I just want to mention, because it's so hot in Seattle and maybe it's hot where you are around the country, and sunny, that tomorrow we're going to have an expert on from the Cleveland Clinic, a dermatologist, Dr. Rebecca Tung. She's going to help us be reminded how to protect your skin, take good care of it, whether it's in the sun or you're trying to deal with wrinkles or whatever. All that coming up at this time tomorrow on Patient Power. Let's go back to our topic at hand, and that is cancer in young adults. And as we were learning, maybe 65,000 to 70,000 young adults in their 20s and 30s and are diagnosed with cancer every year. And also while progress is being made in cancer we haven't been able to change the survival statistics for that age group since the 70s. So there's a lot of 6

7 work in understanding what's going on. People be diagnosed earlier. Have them participate in clinical trials so we can have the research and understanding that can make a difference. Now, you met earlier in the program, and we'll have him continue to be part of the discussion, Dr. Brandon Hayes-Lattin, who is in hematology oncology at Oregon Health and Science University Cancer Institute in Portland, and he was diagnosed and treated for testicular cancer. Yes, just like Lance Armstrong, who he knows pretty well probably by now because he's involved with the Young Adult Alliance of the Lance Armstrong Foundation. So that happened to him, and he's devoted his life to that and other cancer patients. But here we go again. So we have now another doctor, a resident in anesthesiology also at Oregon Health and Science University in Portland, Todd Smaka, and Todd has been diagnosed with a different kind of a cancer, a leukemia, hairy cell leukemia, and he entered a clinical trial just like I did. Todd, welcome to the program. When did this diagnosis happen? And where were you in your medical career when you got this diagnosis. Todd s Cancer Diagnosis in Medical School Good morning. Thank you for having me on. I was about three months ahead of being just graduated from medical school, so I was at the very beginning of my internship. And what were you symptoms? Well, in hindsight I was very tired, but starting a new career I thought maybe I was just tired from working a lot. I had been remodeling a room in my house and I noticed that I would get these little cuts on my fingers and they wouldn't stop bleeding. They would take probably 15 minutes to stop bleeding. And then one night I was lying on my bed and I often fold my clothes on my bed, and I felt like I was on something and I thought maybe I left a shirt on there and felt around, couldn't feel any lumps in the bed, and then I started feeling my belly, and I could feel a big mass in my belly. Oh, my. Now, was this the spleen? This was the spleen. And the spleen is normally about the size of a fist, but in my case it was about the size of a basketball, and it went all the way down into my pelvis, so it was quite large. 7

8 Now, here you are. You're finishing years of medical school, and I imagine along the way there was some exposure to hematology and oncology. Did some light bulb go on and say, oh, my, could this be happening to me? Well, I remembered from my first year medical school learning that if you can feel your spleen then it's too big, at least two and a half times the size. And I thought Oh-oh, my spleen is big, this can't be good. And I really didn't have a clue what it was just because you get scared pretty quickly, so I went in my living room, found my pathology textbook and started looking up large spleen and read the words "leukemia and lymphoma" as a possibility. So it was pretty scary. Yeah, I was going to say do you like break into a cold sweat. I mean, here, it's like, now you weren't a hematologist oncologist so maybe you weren't up on what the treatments were or what could lie ahead, but still you knew it wasn't good. Well, I did know it wasn't good but it probably was about a 20 percent chance that it was going to be either leukemia or lymphoma. The overwhelming likelihood, the 80 percent chance was that it was going to be an infection, specifically mono. Mononucleosis, which a lot of us get when we are younger, can often present with that. There are some other conditions too, so I was really hoping it was that. But I didn't really know for sure, so it was important that I went and sought treatment, which is a big problem in my age group because we feel pretty indestructible, pretty vital, and we don't like that word not doing so well, especially young males. Also combine that with working a lot, trying to start a career, don't really feel like we have time to go to the doctor, don't really feel like And may not have health insurance. We were discussion that in the first half hour. If you don't have health insurance, you don't like to go to the doctor, you're indestructible, and you don't have time, it's like, I can't deal with this. Yeah. And it's terrible and it's a terrible problem for especially our age group. And even if you do have health insurance it can still be a challenge. I mean, how do you get the kids taken care of while you're going to the doctor? There are so many things it's just kind of mind-boggling. And just kind of talking about it right now it takes me back to then and thinking about the mass confusion. You know, how is this going to affect my career? I just started my residency. Am I going to have to drop out? If I drop out I won't qualify for health insurance any more. There's no way I can pay for this myself. What do I do? So what did you do? When finally the diagnosis was confirmed, hairy cell leukemia, which I imagine, leukemia is not common. I would imagine hairy cell leukemia is not common. 8

9 Yeah, hairy cell affects about 500 Americans every year. So that means each state is going to see about ten cases. So that's about once a month per state. So yeah, it's pretty rare, but fortunately it's one of the better ones to have. That was actually told to me, someone said, Oh, you're so lucky. And I'm like, I don't really feel too lucky. Todd, now, here you are a medical person so you're around researchers, and so you know clinical trials are really important, so you entered a clinical trial. Tell us about that and how that's gone for you. Well, actually the first time around I was living in Utah at the time, and that was not a clinical trial. And that went pretty well. I looked for clinical trials or at least the idea, but again I was pretty confused and scared of what to do, so I followed the advice of my oncologist. And it did pretty well. I was cancer-free for about two, two and a half years, but last summer I relapsed. At that time I had moved down to Texas and had started taking treatment at M.D. Anderson Cancer Center, and my oncologist there had said before, Oh, I wish you had looked more into clinical trials. There are some great treatments out there. So when I relapsed I had, I'm sorry this is kind of confusing. I was living in Houston, Texas, had established care there just for follow-up care. I got into residency at OHSU, and then while here that's when I relapsed. I went down to Houston, Texas, and we talked about clinical trials, and he said it was important to try this trial because I had obviously failed on the previous treatment. So this clinical trial took the same drug I was on the first time around but added another drug. At the time I think I was Patient Number 16, maybe Patient Number 17 for this trial. His results looked promising. I thought, well, what do I have to lose? So I got involved with that, started the clinical trial there. Dr. Brandon Hayes-Lattin is my oncologist here in Oregon, and so my oncologist in Texas and my oncologist here worked together to design a treatment plan that would not only be good for my fight against cancer but that would also allow me to maintain employment, to stay where my family and friends are and to try to lead a somewhat normal life. How is it going? Going great. I've been cancer-free now for a little bit under a year. I'll celebrate my one-year anniversary at the end of August. 9

10 Oh, that's great. Now let's talk to your doctor who helps you in Oregon who is with us as well, Dr. Hayes-Lattin. Dr. Hayes-Lattin, help us understand then how important it is as we have these young adults diagnosed with cancer that we offer them the opportunity to be in clinical trials so that maybe we can give them the benefit of tomorrow's medicine today and we can get some answers to some important questions to help young adults generally. Who Benefits From Clinical Trials? We believe strongly that clinical trial participation is a key factor to improve survival rates. And we talked earlier about how there has been really impressive and dramatic improvements in childhood cancers in terms of long-term survivorship rates, and part of that we reflect back on is their rates of participation in clinical trials. So upwards of 50 to 60 percent of kids with cancer in the United States are participants in clinical trials, and with that kind of participation rates we see increases in survivorship going from 50 to 80 percent. But when you go to the age range of 20 to 24 the percent of patients who participate in clinical trials goes to almost nothing. It's less than 5 percent. And at the same time we see this stagnant survivorship rate, no improvement in survivor rate. So we think that that's a critical piece. One thing that I think it's important to point out, and Todd's story tells it, mine does too actually, is while Todd, so you had established care in Houston and there were clinical trials available at M. D. Anderson. Then you had moved to Portland, and you were at another academic medical center and certainly an outstanding one in Oregon Health and Science University Cancer Institute that could help you, so they worked together. Absolutely. And I think that's important for people to understand is there may be a clinical trial that's available here, there and hopefully you'll take a look at it, maybe right where you are, maybe it's at a distance, but often it's very possible to have this collaboration. And I know my treatment continued in Seattle actually through an HMO and yours was there where you were living your life. So that can work out. So, Dr. Hayes-Lattin, help us understand that. For people, whether they are in a trial in Portland with you and live somewhere way out across the state or across the Northwest or someone else listening to us, it's a discussion they could have with their community oncologist about whether a clinical trial might be right for them, and it doesn't mean that they have to give up that relationship with that doctor who is close to home, right? 10

11 Yeah, that's absolutely true. Institutions like the OHSU Cancer Institute or M. D. Anderson or these other institutions we're talking about who are designated cancer institutes from the main government agency, the National Cancer Institute, these NCI cancer institutes were created to make a network of cancer care and clinical trials across the country. So we look at it as our job to facilitate clinical trial participation, not just in people who are diagnosed at our center or who come through our door but to serve a larger communities. So it's very important to us to make that happen. And the other important aspect is that not all clinical trials and not all biological knowledge is gained from treatment. There are opportunities to help in terms of health services research, supportive care research, even banking specimens in tumor banks and those sorts of things are all going to help us in the end goal of increasing cancer survivor rates. So it doesn't necessarily even have to be a clinical treatment trial. There may be other ways to participate, and we urge everybody to ask their local a doctor about how they might participate in these things. I want to point something out to our listeners. So here we have two physicians, one who is a resident in anesthesiology, one who is an assistant professor in hematology oncology, both cancer survivors, both diagnosed as relatively young adults and both speaking out about it. Now, Todd, since often somebody with cancer in your age group doesn't know anybody else, although it turned out your doctor now is a cancer survivor too, wouldn't you say that you'd encourage people to speak out about it so it's better known, people get diagnosed earlier, and we can try to understand what's going on here to provide better care? Absolutely. And it's amazing how many people I've met since being diagnosed with cancer, people I knew before who then have their own story about cancer and then people who I've met who later came up to me and said I was just diagnosed with cancer. It's something that affects quite a few people, and I think especially in this age group we feel somewhat abandoned, maybe, somewhat alone. Yes. Most of us are still single and maybe just started dating somebody, and we're trying to go through those crazy times, and then we get this diagnosis. I actually have three roommates, and one of my roommates was just diagnosed with a terminal form of cancer Wow. 11

12 And how do we deal with that? And he actually was in a situation where he was getting care and not participating in a clinical trial, and I feel very honored to have had the opportunity to talk to him about the importance of clinical trials, and now he's participating in one. So, Dr. Hayes-Lattin, you counsel people and here's Todd too. It seems like it's important to speak out. And there are beyond the clinical issues there are these issues in relationship with other people, and Todd just mentioned it. For instance, if you're single and you want to date do you tell people? What do people talk about? Do you have any recommendations about how public you are or how you get counsel or how you connect with other young adults to just get some guidance or share some thoughts on it? Making Connections with Others It is certainly a major challenge for adolescent and young adult oncology to address all these issues, and there is a long list. It's everything from this feeling of isolation and having an opportunity to meet other people who are going through some shared experience to very practical issues like health insurance, life insurance, what to do about your job, what to do about dating, those sort of things. One of the medical aspects that sometimes gets missed is fertility. What is the impact of your cancer diagnosis and your treatment on your fertility, and is there ways to preserve your fertility for the future? All of these things are sort of in addition to the nuts and bolts of what the cancer diagnosis is and the nuts and bolts of what the treatment is. So many centers and many advocacy groups are trying to coordinate efforts to make it better. One of the things that we've done at OHSU Cancer Institute is create a specific program in adolescent and young adult oncology as sort of a clearing house of these resources. We have traditional support groups. We have more just sort of activities, you know, for young people just to get together and play games and talk without necessarily having a formal support group. We have access through our fertility specialists and through national fertility resources like Fertile Hope. We have access to sort of online communities like Planet Cancer and the Lance Armstrong Foundation to sort of bring people together to make sure that young adults have an opportunity to consider all these various aspects of their cancer experience and that we do it in an age-appropriate fashion and we do it in a timely fashion so it really helps people. I think it's important for people to know they're not alone. And while you can feel very alone, and I did at age 46 with chronic lymphocytic leukemia, which used to be thought of as an older person's leukemia, once I started to connect with people and store groups on the internet, I got involved in a leukemia society, I started meeting people who were in 12

13 my situation. We used to, even in Seattle, we started to meet for coffee and lunch every once in a while. It made a huge difference, and so I'd really recommend that to people. Now with the Young Adult Alliance of the Lance Armstrong Foundation, Dr. Hayes-Lattin, how about that? What's website? How do people connect? How can the Lance Armstrong Foundation help them if they find themselves in a situation just like Lance and like you? So the Lance Armstrong Foundation and particularly this Young Adult Alliance has really brought together a lot of these resources that exist not just within the Lance Armstrong Foundation but across the United States. And the best way to find that is either through their website, which is and you can search for the Young Adult Alliance link there. Or in our own program our website is back slash AYA, for adolescent young adult, AYA, and we have links there too to many of these resources. Well, again, people are not alone. So, Todd, you counseled your roommate and you think about yourself and you're doing well. What's your outlook for the future now? How do you approach today? How do you approach your medical career? How do you think the future? Well, I'm very excited. I'm actually getting married here in about seven weeks. Great. I think it just reoriented my view on life and what are my priorities. Definitely my relationship with my faith, my relationship with my family, my friends take priority. And I think part of my relationship with my faith and my family have to do with working hard in my career to protect people the best I can and to help people the best I can. And so I really feel kind of altruistic a little bit towards the medical field and really wanting to do the best work I can there. But I also I think more than anything it just really helped to re-center my priority and my relationship with other people and my community. And it just has made me a lot more open and talkative, and I just want to meet as many people as I can and talk to as many people as I can about anything, whether it be cancer or other things. But definitely it just gives me such joy and pleasure and honor to be able to interact with my fellow humans and just live life because who knows what can happen tomorrow. Right, for anybody in any situation, absolutely. 13

14 And, Dr. Hayes-Lattin, so you have devoted yourself to folks with cancer and special emphasis on people who are going down the road that you've gone down as a young adult. Are you optimistic about the future, both for yourself and eventually making progress in this segment of people with cancer? Yeah, this is actually a really exciting time to focus on this area because it does have the attention of major cancer institutes, major advocacy groups, including the efforts of the Lance Armstrong Foundation. It also, these issues of adolescent young adult cancer has caught the attention of the National Cancer Institute, and together the Live Strong Young Adult Alliance and the National Cancer Institute have formed a really unique partnership for making an action plan for change. In fact we had our first annual meeting of these two groups last November where we came up with a structure and a strategic plan, a structure of task forces that one is a science task force, one is a sort of a standard of care task force, one is an awareness task force, and each of these task force groups has specific action items and has identified partners and resources to make change. So it's a really exciting time, and I think we're going to see more and more cancer institutes devoting space and attention to adolescents and young adults. I think that's going to lead to more clinical trial availability, more age-appropriate standard of care, and those are again going to improve cancer survival rates and also just the general experience of having cancer as a young adult. Well, I want to wish both of you all the best in your medical careers and your devotion to this particular situation, cancer in young adults. So, Todd Smaka, best of luck in your anesthesiology career. Congratulations on your upcoming wedding. All the best to you, Todd. And, Dr. Brandon Hayes-Lattin, your career in hematology oncology and your work with the Young Adult Alliance at the Lance Armstrong Foundation, best with that. I want to repeat some websites. So the OHSU website, ohsu.edu, and it's actually forward slash, leaning to the right, AYA, is the adolescent and young adult program. So, folks, thank you for joining us. Spread the word to people in this age group so that they're alert about cancer and get the diagnosis and the treatment they need. As always, knowledge can be the best medicine of all. Andrew Schorr. See you tomorrow, signing off. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. 14