Kelly is the chair of the Department of Pediatric Oncology, as well as the Waldemar J. Kaminski Endowed Chair of Pediatrics, at the Roswell Park Comprehensive Cancer Center, located in Buffalo, New York.

Dr. Kara Kelly

Dr. Kara Kelly discusses specific long-term health considerations that AYA survivors of lymphoma should be aware of to best prepare for survivorship.

Preparing For Survivorship After Lymphoma Treatment in AYA Patients

The treatment of adolescent and young adult (AYA) patients with lymphoma — a type of blood cancer — varies from the therapeutic plans used in pediatric or adult patients, requiring unique considerations for this underserved patient population, according to Dr. Kara Kelly, a pediatric oncologist.

Particularly, there are specific long-term health considerations that AYA survivors of lymphoma should be aware of in order to best prepare for survivorship after treatment. In order to further discuss this topic, Kelly sat down for an interview with CURE.

She is also the chair of the Department of Pediatric Oncology, as well as the Waldemar J. Kaminski Endowed Chair of Pediatrics, at the Roswell Park Comprehensive Cancer Center, located in Buffalo, New York.

Fortunately, most of the lymphoma types we see in the adolescent and young adult age group are very treatable and associated with high survival rates and good response to therapy. These patients are likely to be cured, and being fairly young, they have a very long life ahead of them. However, with this, we unfortunately do see the emergence of late toxicities from therapy, especially from the more conventional treatments that have been part of our therapeutic options.

For example, in Hodgkin lymphoma, up until recently, the standard had been to combine chemotherapy with radiation treatment. With this approach, our long-term survivors can experience higher rates of developing second cancers, like breast cancer or thyroid cancer, because of the areas where the radiation fields were directed. High cumulative doses of chemotherapy, particularly doxorubicin, can increase the risk of long-term cardiovascular complications like the early development of congestive heart failure or a higher risk of strokes and valve problems.

Additionally, some chemotherapy agents are associated with an impact on fertility. Our female survivors are at higher risk for developing premature menopause, while male survivors are at risk for not being able to produce sperm anymore. Therefore, it is very important that our survivors have an oncofertility consultation at the time of diagnosis, so they know what their options are, especially regarding the cryopreservation of eggs or sperm, to give them more options after their therapy is complete.

Transcript has been edited for clarity and conciseness.

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Dr. Kara Kelly discusses specific long-term health considerations that AYA survivors of lymphoma should be aware of to best prepare for survivorship.


Dr. Kara Kelly discusses some of the most common challenges faced by adolescent and young adult patients with lymphoma.

Breaking Down Barriers to Diagnosis in AYA Patients With Lymphoma

Adolescent and young adult patients (AYA) with cancer, particularly lymphoma, are presented with challenges that other patients with the disease do not face, sometimes even before their initial diagnosis, according to Dr. Kara Kelly, a pediatric oncologist, who cites delays in diagnosis as one of the biggest challenges for this patient subgroup.

To further discuss the topic, Kelly sat down for an interview with CURE to discuss some of the most common challenges faced by AYA patients with lymphoma, highlighting some initiatives and strategies that may help address these challenges.

I think one of the biggest challenges for patients who develop lymphoma in that age group is that there are often delays in diagnosis. AYA’s tend to be healthy in general, and they are also in a transitional period in their lives, moving out from their parents' homes to study or take their first jobs. Many of them don't have a primary care doctor or health insurance.

Unfortunately, this leads to a lot of misdiagnosis or delays in diagnosis of lymphoma because either physicians are not considering lymphoma as the cause of their symptoms, or patients may not have health insurance or know where to seek help and may postpone seeing a doctor until the lymphoma is in a much more advanced stage. This delay or misdiagnosis is a major concern in this population. The second challenge is that these patients are somewhat in the gray zone between pediatric and adult oncology.

For some subtypes of lymphoma, there have historically been quite different approaches to managing these patients. My area of expertise is Hodgkin lymphoma, and one of the things that has really struck me is that an 18-year-old patient who comes in with Hodgkin lymphoma might receive a totally different treatment recommendation compared to if they were seen by one of my adult oncology colleagues down the hall.

There has been a real need for us to come together — the pediatric and adult oncology disciplines — and try to harmonize our processes. Fortunately, this is one area where we are really beginning to see the results of these collaborative efforts. Now, we don't have a separate pediatric or adult recommendation but a recommendation that is truly the best for adolescents and young adults with lymphoma.

Dr. Kara Kelly

Preparing For Survivorship After Lymphoma Treatment in AYA Patients

Breaking Down Barriers to Diagnosis in AYA Patients With Lymphoma

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