Expanding Resources, Clinical Knowledge to Enhance AYA NHL Care: Andrew Evens, DO

Last month, Andrew Evens, DO, MBA, MSc, Rutgers Cancer Institute and Jack & Sheryl Morris Cancer Center, joined The American Journal of Managed Care^® (AJMC^®) to spread awareness about the particular challenges that impact adolescent and young adult (AYA) patients with forms of Hodgkin and non-Hodgkin lymphoma (NHL). Later on, he discussed the value of expanding clinical knowledge of lymphoma biology, which could inform the management and treatment of lymphoma in AYA populations.

Building on these topics, Evens spoke to pertinent gaps that influence NHL care for AYA populations: lacking screening protocols, access, and insurance considerations. For these reasons, he added, primary care providers play an important role in addressing the needs of these patients. While early screening measures are insufficient, he discussed the available resources for those seeking to manage a new diagnosis, patients and their clinicians alike.

This transcript has been lightly edited for clarity.

AJMC: Can you speak to the value of early detection and screening strategies for NHL, and any related challenges here?

Evens: There are not real screening strategies, but in a way, that's not a surprise; there are a hundred different cancers. There are really only 4 or 5 that have cost-effective screening methods: breast cancer, colon cancer, gynecologic cervical cancer, prostate cancer, and sometimes lung cancer. Most other cancers don't have a screening, partly because we don't have a real test to do it. Also, the incidence is not as high. Those are much more common cancers, although that waxes and wanes. This is why it can be unclear what should or should not be done for screening.

AJMC: What resources are available to AYA patients with NHL who are managing a new diagnosis?

Evens: There are resources out there in general, whether through the Lymphoma Research Foundation, American Cancer Society, and others. But I can't say a lot of that information is tailored in any form or fashion to AYAs. It's more general to Hodgkin or diffuse large B-cell lymphoma, or others, and we need more. We need more to address many of the issues from the very beginning, not just the biology and the diagnosis, but some of the social factors, access to health care, and financial toxicity. If you have insurance, get access, get a good treatment, how do you navigate the financial aspects, and what about survivorship care? There’s a lot of general information, but we need more tailored to this specific patient age group.

AJMC: Can you speak to the health barriers that impact AYA patients’ ability to access timely, quality NHL care?

Evens: It starts with the (A) access and (B) insurance. Many don't have a primary care provider that they’re seeing once or twice a year and doing exams. Therefore, they might let something persist longer than they should. They’re not already docked in with routine health care. And then, do they have insurance and access? That's a barrier.

Navigating those social factors of being a new younger adult, wherever you are within the 15-39 age spectrum, those are barriers to address as well. There are some resources that hospitals have to help patients. But I can tell you, it's heterogeneous. Rutgers Cancer Institute is a very large cancer center with resources. Our pediatric colleagues at RWJBarnabas Health also have a program called Child Life Services that has extra social workers, oncologists, psychologists, and some financial navigation services for patients.

I think those are hopefully barriers that can improve over time. And not just at the academic center but at our community oncology colleagues; if they don't have resources in their office, there could at least be information somewhere online where patients could go, even if it's remote video counseling.