Addressing Unmet Needs for Young Women Before, During and After a Cancer Diagnosis

Supportive care must be integrated earlier to meet the unique emotional, practical and fertility-related needs of younger women facing a cancer diagnosis.

Urgent, systemic changes are needed in the research, diagnosis and treatment of younger women with cancer, as this patient populations rising incidence in cancer has not been adequately addressed by older standards of care, according to a news release from City of Hope, that went on to emphasize the importance of establishing a national standard for supportive care, expanding access to personalized risk assessments at a younger age and investing in age-specific research.

To further delve into this topic, Natalie Schnaitmann, executive director of the Department of Supportive Care Medicine at City of Hope, located in Duarte, California, sat down for an interview with CURE. It was in this discussion that she emphasized the urgent supportive care gaps that she encounters in her work. Furthermore, she addressed specific options young women with cancer should be aware of at diagnosis, what barriers are still present.

“Making supportive care a standard of care means it's built into the fundamental care model,” Schnaitmann explains. “As I've said many times, there isn't a single patient or family facing cancer or cancer treatment who doesn't have a supportive care need. Whether it's physical symptom management, practical concerns, psychological distress [or] emotional challenges, these becomes a real challenge for all our patients and families.”

CURE: From your perspective, what are the most urgent supportive care gaps you encounter in your work, and how do they affect long-term quality of life for younger women with cancer?

I would say it's hard to identify what's most urgent for a patient and family, because whatever supportive care gap they are experiencing, it is urgent to them. Through screening and working with tens of thousands of patients, we understand the common needs that arise, and it's important for us to address those upfront. Since it's often their first time facing cancer, we know the right questions to ask regarding their practical, social, emotional, and physical supportive care needs. However, it's crucial to personalize this for the individual patient and family sitting right in front of you, asking the right questions to uncover what is most concerning for them.

For young women in particular, which is our current focus, fertility preservation is an extremely important topic. It's vital to bring this up early, asking questions in a way they can understand the consequences, opportunities, and implications. However, this young patient population isn't only comprised of women who haven't had children yet. Some young women may have already completed their families, making fertility not their top concern. They might be dealing with parenting, often young children, and perhaps already balancing a demanding career, which is challenging enough without adding cancer and its treatment.

While fertility might not be their focus, addressing parenting issues becomes critical. This includes basic concerns like: “How am I going to get myself to treatment when I'm feeling terribly ill and immunocompromised?” Or, if they have a partner who needs to work and can't safely use public transportation, fundamental questions arise: “Who's going to watch the kids when I'm gone? Who's going to take them to school or soccer practice when I have an eight-hour chemotherapy session or am hospitalized?” These are very difficult, day-to-day practical questions that can become significant barriers to care for young women.

Beyond the scope of children, not everyone is dealing with those specific issues. You might have a young couple. We have a special “Couples Coping Together Against Cancer” program, recognizing the incredible strain any couple experiences going through this together. Young couples sometimes have fewer years of building their stress tolerance together. Finances can also be a really big deal for younger individuals, impacting their ability to work, especially if their career or insurance depends on that work. That's a lot.

You’ve emphasized the importance of normalizing conversations around fertility preservation early in the cancer journey. What specific options should young women be aware of at diagnosis, and what barriers still prevent these conversations from happening universally?

The first step is to normalize fertility preservation as a standard of care. We talk about standard of care, checklists, and questions that we, as healthcare providers, should be responsible for asking patients upfront. However, these often become mere checkboxes during the first appointment, when patients are completely overwhelmed, trying to process a new diagnosis, understand the upcoming treatment, figure out how they'll manage it all, and often, in that initial appointment, even wondering if they'll survive the word ‘cancer.’

To create appropriate space for these crucial conversations, it's essential to schedule them at the right time—a calm space, perhaps a second appointment. Similar to how we approach genetic testing, we can say, “You know what, fertility concerns come up for a lot of our patients.” Again, normalizing it helps. “We want to be really sure that you understand the risks that come from your cancer treatment and the options available to you. Is this something that matters to you?” Then, it's vital to follow up, not just in that first meeting. So, creating the right space and finding a time that isn't the initial appointment, but prior to treatment scheduling, is key.

What often happens is, I don't want to say a false sense of urgency, but sometimes an elevated sense of urgency to start treatment ‘tomorrow morning’ or ‘in a week.’ Sometimes that's true, but rarely is it so urgent that it impacts your quality of life for the rest of your life. It's worth considering the options that matter there, and perhaps starting treatment in two or three weeks is feasible, whatever that might look like.

Normalizing truly requires the right language. I mentioned many people experience this—when you can really take away the feeling of, “Well, you're asking something out of the norm, and we're just trying to treat your cancer here. Why are you asking about this?” Some patients genuinely get the sense that, “Oh, this is the doctor, and they're here to treat my cancer, and nothing else is something I can bring to this conversation.”

Finally, to address some specific barriers, I think the medical model we operate within doesn't always allow time for providers to cover everything, especially sensitive aspects that take longer to discuss. Again, there's that inflated sense of urgency to really start treatment immediately. And to be honest, there's still some discomfort around tough topics, not only fertility but sometimes the various emotional subjects that our providers are not trained to discuss, which elevate emotions and difficulties for our patients and families. They sometimes just want to move through to the treatment options.

The final thing I'd say is perhaps it's a tough conversation to bring up if there's a perceived or real lack of resources to help. If a provider doesn't know what might be able to be done for these patients, these women, regarding fertility preservation, or what resources are available and how they'll get financial assistance for them, they might be a little more hesitant to bring it up.

How should supportive care evolve to meet the unique psychosocial and practical needs of this demographic during and after treatment?

To be effective long-term and during treatment, supportive care needs to be introduced early and integrated into the care model.

Palliative care, or what we call supportive medicine, focuses on pain and symptom management. It ensures that treatment plans align with a patient's values and goals. Crucially, it is not end-of-life care or hospice. Bringing these conversations in early allows patients to build a relationship and understand what's available to them before they face a pain crisis or tough decisions.

Making supportive care a standard of care means it's built into the fundamental care model. As I've said many times, there isn't a single patient or family facing cancer or cancer treatment who doesn't have a supportive care need. Whether it's physical symptom management, practical concerns, psychological distress, emotional challenges, social issues, or spiritual needs, at least one or many of these becomes a real challenge for all our patients and families. If this holds true for every person facing cancer, then it must also hold true that supportive care is an early, integrated, and standard part of every person's cancer treatment.

We need targeted educational materials — booklets, videos and readings — available in multiple languages. We also need appropriate staffing and resources to provide this care. If an oncology center is going to hire an additional surgeon or chemotherapy nurse because that's what patients demand, then it also demands a clinical social worker and someone specializing in palliative care.

If these resources aren't on staff, which is the ideal way to integrate them into oncology care, then those community partners need to be thoroughly vetted and genuinely integrated into the care pathway. This ensures that everyone truly receives the supportive care they need. This is the direction supportive care needs to move and evolve within these core models, becoming fully integrated into cancer care.

Transcript has been edited for clarity and conciseness.

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