Young Adults With Advanced Cancer Lack Access to Concurrent Palliative Care

Despite clinical guidelines recommending the integration of supportive services at the time of diagnosis, a new nationwide cohort study reveals a significant gap in care for one of oncology’s most vulnerable populations.

Published in JAMA Network Open, the research indicates that less than 20% of young adults (aged 18-39) with advanced cancers receive concurrent palliative care (PC) while undergoing systemic treatment.

For oncology nurses, who often serve as the primary coordinators of care and the first point of contact for symptom management, these findings underscore a pressing need to bridge the divide between active treatment and supportive care.

The Growing Gap in Supportive Care

The study, led by Kewei Sylvia Shi, MPH, of the American Cancer Society (ACS), analyzed data from 67,706 young adults diagnosed with stage IV solid tumors or poor-prognosis high-grade brain tumors between 2010 and 2023. While the utilization of concurrent PC increased from 9.3% in 2010 to 18.3% in 2023, the overall rates remain startlingly low. Between 2021 and 2023, only 17.1% of this population received PC alongside cancer-directed therapy.

"Palliative care can help address symptoms, support decision-making, and improve quality of life during treatment, yet many young adults are still not receiving these services," Shi stated in a press release. This is particularly concerning as the incidence of early-onset cancers continues to rise.

Disparities in Utilization

The research highlights several demographic and institutional factors that influence whether a young adult receives supportive services.

Patients receiving concurrent PC were more likely to be:

• Between the ages of 35 and 39.
• Female.
• Medicaid-insured.
• Treated at community cancer programs rather than academic or NCI-designated centers.

Furthermore, utilization varied significantly by cancer type. Young adults with lung (39.1%), gastric (32.6%), and kidney (29.9%) cancers saw the highest rates of PC integration. Conversely, rates were lowest for those with Hodgkin lymphoma (1.9%), non-Hodgkin lymphoma (4.1%), and brain tumors (4.3%). Researchers suggest these variations may reflect differences in symptom burden or clinician comfort rather than standardized referral patterns.

The Oncology Nurse’s Role in Overcoming Stigma

One of the most significant hurdles to PC integration is the persistent stigma and misconception that palliative care is synonymous with end-of-life care or the cessation of active treatment. Oncology nurses are uniquely positioned to educate patients and families that PC is specialized medical treatment focused on providing relief from the symptoms and stress of a serious illness, intended to be delivered concurrently with curative-intent therapies.

Dr. Arif Kamal, Chief Patient Officer at the ACS and a palliative medicine specialist, emphasized that the goal is to see "the person beyond the diagnosis." For young adults, this means addressing unique developmental challenges related to education, career stability, and family building, all of which are profoundly disrupted by a cancer diagnosis.

A Tiered Approach to Care

Given the national shortage of specialty PC clinicians, the study authors suggest a tiered approach to care delivery. In this model, primary palliative care—including basic symptom management and psychosocial support—should be integrated into routine oncology nursing care. Specialty PC referrals can then be reserved for patients with more complex supportive care needs.

"We need to get this population the care they need," Shi urged. For the oncology nursing community, this serves as a call to action to advocate for earlier referrals and to ensure that supportive care is viewed not as a last resort, but as a foundational component of comprehensive cancer treatment.

Looking Ahead: Policy and Advocacy

The findings also provide a basis for policy advocacy. Lisa Lacasse, president of the ACS Cancer Action Network, noted the "pressing need for policies that will improve access," specifically urging Congress to pass the Palliative Care and Hospice Education and Training Act. This legislation aims to expand research funding and train a larger workforce capable of providing the "whole person" care that young adults desperately require.As the oncology landscape evolves, the integration of PC remains a hallmark of high-quality, compassionate care.

For the oncology nurse, ensuring that 100% of eligible young adults—rather than just 18%—receive these vital services is the next great frontier in patient advocacy.

References

1. Shi KS, Ji X, Brock K, et al. Concurrent Palliative Care and Systemic Treatment Among Young Adults With Advanced Cancer. JAMA Netw Open. 2026;9(7):e2624907.
2. doi:10.1001/jamanetworkopen.2026.24907American Cancer Society. Only One in Five U.S. Young Adults With Advanced Cancer Receive Palliative Care as Part of Treatment, Study Shows. Published July 23, 2026. Accessed July 24, 2026.