Treating Younger Patients With Colon Cancer

Cathy Eng, MD, FACP, FASCO, of Vanderbilt-Ingram Cancer Center, comments on colon cancer diagnoses on the rise in younger patients, and how she approaches treatment considerations and management for her younger patients.

—

Dr. Eng: Currently, we treat these patients in a very similar fashion to any other patient diagnosed with stage 4 disease. Everyone should get NGS testing. Everyone should be tested for microsatellite instability. And for our young patients, I highly encourage germline testing to make sure they do not have an inherited familial syndrome, because that could impact family members and could work in the preventative aspect for them.

We also want to know if they may benefit from immune checkpoint inhibition, obviously by checking for microsatellite instability. But currently for our young patients, they receive the same type of therapy as our average age adult patients, just because we have not found any unique molecular markers.

The reality is they have different challenges. They are trying to go to work every day. They are trying to not be penalized for being away from work for so long. They are concerned about financial toxicity. They are trying to raise a family. So, they have their own very unique obstacles that they have to face once they are diagnosed.

I think the best thing that any provider can do for these patients is, number one, make sure that they are receiving appropriate fertility testing. We want to make sure whether they want to have additional children. That is the most important thing before starting any therapy. Make sure they get their genetic counseling.

Then, really make sure that they have the support services they need in order to optimize their care, including psychosocial support, whether or not they need psych oncology or just social work. Whether or not they would benefit from palliative care or supportive oncology, pain management, etc.

We need to make sure these patients have a primary care physician. At every aspect, we are trying to make sure everything is covered. So, when they are receiving their treatment, their chemotherapy or immunotherapy, or any clinical trial for that matter, they feel that they know who to turn to if they are having any potential emotional or physical setback. I think it is extremely important.

View her continued comments.