I had the pleasure of speaking with one of our Cancervention presenters, Dr. Dava Szalda. Dr. Szalda is originally from New York and has been in Philadelphia for the past 8 yeas at Penn and the Children’s Hospital of Philadelphia.
Why did you want to become a physician?
I always was thinking about medicine from a pretty young age. When I was in medical school thought about being pediatrician, because I loved working with adolescents and young adults. That age group kind of seems too old for pediatricians and too young for internal medicine and family doctors. Knowing that I wanted to focus on adolescents, I wanted to be trained in both areas. I also chose to have some subspecialty training in oncology because I thought young adults with cancer are a pretty unique group of people.
Why did you choose the field of oncology?
I really thought that the patient relationships developed in oncology are really special and unparalleled in other subspecialties. I found that working with patients affected by cancer was among my most profound and rewarding experiences. I do feel that I am a primary care doctor at heart, because I really like to care for the whole patient, which involves mental health, psychosocial health, taking care of the organs, and so on. I found that cancer survivors need a heightened form of primary care. It was clear to me that this group was special and unique.
What makes this group unique and what are some issues pertinent to them?
In general, this middle group is a little lost between pediatric and adult care. It’s frustrating as a clinician. There is also the question of where I can best access these patients, a cancer center or primary care practice?
I think it is important to address how to integrate your cancer, condition and survivorship into your life. That task is not easy for a child or adult, but for an adolescent it might be even more difficult. They’re dealing with relationships, families, schooling, and careers. Their experience is very unique, and I think it is important for them to have resources to help them manage their health and life events.
I do think parents and care providers are a great resource. At the same time, you need to honor, encourage, and build the autonomy of the patient and the independence of the patient, especially if it is a young adult, someone living in college. I feel that management of healthcare really needs to be a shared responsibility. I think the ideal situation is that the patient is taking the lead, and the parents and healthcare provider are a support system. Things like going to an appointment, managing your insurance card, making the copayment…these are all things the it is important for young adults to be responsible for.
Do you have any particular research interests at the moment?
I am interested in the best models of care and practices for cancer patients and survivors. One example might be the question of how to best provide information to other healthcare providers. When examining a sample of cancer survivors from the Children’s Hospital of Philadelphia, almost half of them (45%) are not getting any follow up care relating to their cancer as young adults. The remaining 55% were getting care, but were not all having specific conversations with their doctors regarding their potential late effects of cancer therapy. This sample represents an important area of healthcare that needs to be addressed.
A specific group I am interested in are young adults at risk of breast cancer because of prior cancer therapy (chest radiation). How can we continue to educate this group and understand why they choose to screen or not screen? I am interested in the presentation of a clear, concise, and complete plan of what care should look like. I think this is something that will be important for young adults and how they manage their health.
What challenges have seen young adults with cancer face, and what do you believe is their biggest challenge?
A lot of young adults face the anxiety around cancer-related follow up care or are anxious about their cancer coming back. Another example that I have seen is that among many cancer survivors and patients starting relationships and getting married, there is a lot of concern about fertility. These sorts of issues are in addition to all the social issues that come with being a young adult.
What is one thing that you think you could change about healthcare that would have a great impact?
I think really good communication and documentation between healthcare providers can be powerful. A lot of information is just lost when switching doctors or institutions. The use of electronic medical records has a lot of power. I also think having teams really dedicated to thinking specifically about the needs of adolescents and young adults has a lot of potential. For example, at CHOP Oncology, there are people offering support and psychosocial resources. Such resources are important in treating young adults.
In choosing between pediatric care and an adult hospital, where do you think young adult oncology best fits?
I don’t think there is any natural preference. Some cancers that can affect someone who is 20 years old occur more frequently in kids than they do in adults. A pediatric treatment center might more sense in this situation. However, if a 20 year old is diagnosed with breast cancer, then it would make more sense for them to be treated in an adult hospital. In deciding between pediatric and adult care for young adults, it is important to take into account the disease and the quality of treatment available.
I think the patient should go where the disease expert is, and all the support resources should be available wherever that may be. My ideal is that everyone should be treated by an expert in their disease, along with being great at working with young adult. They should also have a support system in place that includes resources like counselors, psychosocial professionals, etc.
How did you learn about YACC and the upcoming Cancervention?
I actually met Dakota when she came to Penn and was interested in partnering with Penn to help with the conference. I obviously have an interest in young adult survivors and when I attended the meeting, I thought it would be a great resource to have the support system she was describing.
I am encouraged by the number of people who recognize that, while we’ve made advances, there is much more work to be done for young adults with cancer and in survivorship. Young adults with cancer make up a unique group and have unique needs.
Dr. Szalda will be presenting at the Cancervention highlighting some of the common effects (both physical and psychosocial) people face from therapies. The format will be open dialogue and discussion, and Dr. Szalda is looking forwarding to engaging with members of the community!
-By Bilal Mohammad