ASH Clinical News September 2016 | Page 57

FEATURE Features The years spent transitioning from adolescence to adulthood are flush with emotional, financial, and social challenges, but for young adults who are also dealing with a hematologic malignancy or chronic condition, these transitional years have many added layers of complexity. As adolescent patients move into adulthood, they are often moving from a state of dependence to independence – like moving from high school to college or from their parents’ house to their own apartment – but that also means suddenly being responsible for their own medical appointments, medications, and health-care insurance. “For patients with a chronic illness, transitioning care from a pediatric to adult setting can be a really difficult time,” said Harriet Bering, MD, site medical director of Harvard Vanguard Medical Associates, an affiliate of Atrius Health, in Cambridge, Massachusetts. “Many patients are very attached to their pediatric providers. Getting to know a new team after having a long illness can be difficult – especially during this critical time when people are going through the maturing process with all the different emotional issues related to it.” A variety of hematologic conditions can be diagnosed during childhood or adolescence (between the ages of 10-19 years, according to the World Health Organization’s definition). These conditions can range from childhood leukemias or iron deficiencies to even rarer conditions like hemophilia or sickle cell disease (SCD), which require long-term, complex, and specialized care. ASH Clinical News spoke with several physicians about transitioning young adult patients to the adult system and what can be done to make this transition smooth and successful for the patient, their caregivers, and their health-care team. Is Age Just a Number? Coming of Age The transition and transfer of patients with hematologic conditions from pediatric to adult care often comes at a crucial time. ASHClinicalNews.org In most states, the legal age of adulthood is 18 years, though the same may not always be true when it comes to health care. “There is really no clear age of transition, and the age seems to differ according to where the patient is being treated,” said Anjali Advani, MD, a staff physician in the Leukemia Program, Department of Hematologic Oncology and Blood Disorders and director of inpatient leukemia at Cleveland Clinic in Cleveland, Ohio. “Here at Cleveland Clinic, we tend to see many patients that are 18 and older, but I know of other places with pediatric programs where they will sometimes see patients into their 30s.” According to Amy E. Sobota, MD, MPH, a pediatric hematologist/oncologist at Boston Medical Center in ASH Clinical News 55