GOAL: Improve access to quality care and supportive resources for individuals and families impacted by cancer among children, adolescents, and young adults.
Childhood cancer is the leading cause of death from disease in children, according to the CDC.lxxxviii Cancer is often considered a disease of aging, and cancers in children are rare compared to cancers diagnosed in older adults. Despite this, thousands of children, adolescents and young adults are diagnosed with cancer each year. In Nevada in 2022, the most recent year in which data is available, there were 551 cancer diagnoses among children, adolescents, and young adults up to age 34.lxxxix Data from the National Childhood Cancer Registry shows that incidence of CTYA cancers has gradually increased over time, especially among people of color.xc The most common types of cancer in children and adolescents are leukemias, lymphomas, and cancers of the brain, central nervous system, and bones. Young adults are most commonly diagnosed with breast cancer, lymphomas, melanoma, sarcomas, thyroid cancer, cervical and ovarian cancers, testicular cancer, colorectal cancer, and brain and spinal cord tumors.
Advances in treatment and supportive care have improved cancer survival among the CTYA population and have also contributed to a growing number of cancer survivors, many of whom live with the long-term impacts of treatment and require lifelong surveillance. CTYA survivors may experience “premature/accelerated aging, cardiotoxicity, endocrine dysfunction, reproductive health issues, secondary cancers, financial toxicity, neurocognitive deficits, and psychosocial concerns,” according to data from the National Cancer Institute.xci The survivorship needs of CTYA cancer survivors differ from those of adults, and the need for support extends beyond the patient, to parents, siblings, and care partners.
Cancer treatment options for individuals in the pediatric and adolescent populations are limited in Nevada, with in-state treatment confined to Reno and Las Vegas. Additionally, Nevada does not have a standalone children’s hospital or a centralized and integrated system of care and is lacking many of the services that are available in other states. Nevada’s healthcare workforce, and especially the pediatric workforce, is severely limited with just 456 general pediatric physicians—about half of the national average,xcii and data is not available on provider counts for pediatric sub-specialties. Because of these limitations, many of those in the CTYA population must travel out of state for cancer treatment, increasing the burden on families and care partners, creating challenges for coordination of care, and contributing to adverse outcomes including financial toxicity and limited access to psychosocial and long-term support.
| Total Physicians | Office-Based | Hospital-Based | Other | |
|---|---|---|---|---|
| Clark County | 356 | 269 | 75 | 12 |
| Washoe County | 79 | 63 | 12 | 4 |
| Carson City | 10 | 7 | 3 | 0 |
| Rural/Frontier Counties | 11 | 9 | 2 | 0 |
| State Total | 456 | 348 | 92 | 16 |
A survey of pediatric oncology professionals practicing in Nevada identified a number of key needs to improve cancer care and survivorship for individuals in the CTYA population. Recommendations included expanding the state’s pediatric healthcare workforce—including general pediatrics practitioners and a variety of sub-specialties—and establishing a freestanding comprehensive cancer hospital or National Cancer Institute-designated facility, resulting in collaborative, multi-disciplinary, and trauma-informed care and a teaching facility for residents and fellows. A more robust menu of treatments and services must also become available in-state to treat CTYA cancers, including bone marrow transplant, gene therapy, CAR-T therapy, immunotherapy, pediatric radiology, and pediatric anesthesia services for radiology and radiation therapy.
Additionally, supportive services for CTYA patients and their families are essential to improving quality of life during and after treatment. In the clinical setting, identified supports to improve care include more robust mental health screening and access to counseling for patients and their families, including siblings; increased access to palliative care; and expanded telemedicine including for care coordination, genetic counseling, clinical trials enrollment consultation, and mental health/psychosocial support. Nevada also has just one long-term follow-up clinic to evaluate the health of survivors following treatment and identify any late effects of treatment. Regular follow-up allows for early detection and management of these late effects, potentially mitigating their impact, but is not available to all CTYA survivors in Nevada.
In the community setting, a number of nonprofit organizations support pediatric and adolescent survivors and their families and have done so for decades. Their support includes helping to reduce or remove transportation barriers, providing financial assistance, increasing access to counseling, and offering activities and camps for survivors and siblings. These organizations also advocate for increased funding to support pediatric cancer research and supportive programs. However, opportunities exist to expand the support CTYA survivors receive, including providing financial counseling and navigation, along with financial literacy education, and navigation to community services and resources.
A newly-formed Pediatric and AYA Cancer Collaborative aims to increase collaboration among organizations serving CTYA survivors and their families, creating opportunity to make substantial progress in reaching this plan’s objectives.
Data Objective and Indicator
Objective: Increase the availability of data for pediatric, adolescent and young adult cancers through complete, accurate, and timely reporting to Nevada’s Central Cancer Registry and proactive epidemiological reporting.
Strategies:
- Educate stakeholders, including policymakers and organizations like the Rare Disease Advisory Council and Patient Protection Commission, on pediatric and AYA cancer impacts.
- Support data reporting to Nevada Central Cancer Registry and/or a rare disease/pediatric cancer registry.
- Support collaboration among community-based organizations to report qualitative data on the impact of pediatric and AYA cancers on families.
- Increase published cancer data reports on pediatric and AYA cancers, including data on incidence, mortality, survival, regional data, financial toxicity, supportive services or other data points critical to improving outcomes.
- Work with federal agencies including the CDC, NCCR (National Childhood Cancer Registry), CCDI (Childhood Cancer Data Initiative), and NPCR to enhance Nevada’s participation in federal pediatric and AYA cancer data initiatives.
Indicator:
Annual number of pediatric and AYA cancer reports produced.
Baseline: 1
Target: 2
Source: NCCR and Childhood Cancer Community Organizations
Clinical Research Objective and Indicators
Objective: Expand access and participation in research and clinical trials for pediatric and AYA patients.
Strategies:
- Develop and disseminate education campaigns to inform the public about pediatric cancer research, including clinical trials, and the importance of participation.
- Develop and disseminate a toolkit for how pediatric and AYA patients can participate in research and clinical trials that includes education for parents and caregivers.
- Educate providers on best practices in discussing clinical trials with AYA patients.
- Share survivor mentor stories on participation in clinical trials.
- Increase support for research teams through improved administrative and research infrastructure.
- Support participation in tumor boards to facilitate participation in clinical trials.
- Increase the use of telemedicine for clinical trial enrollment.
- Identify barriers and facilitators for patients to participate in clinical trials in Nevada and publish findings.
Indicators:
Number of Nevada-focused resource repositories housing information and tools for AYA participation in clinical trials.
Baseline: 0
Target: 1
Number of educational sessions for providers on pediatric or AYA clinical trials.
Baseline: 2
Target: 6
Access to Treatment Objective and Indicators
Objective: Expand access to timely and comprehensive treatment for pediatric and AYA cancers within Nevada.
Strategies:
- Increase provider education on recognizing the signs and symptoms of pediatric cancers and available family support resources.
- Support efforts to retain pediatric providers and graduating physicians within the state.
- Assess the need for sub-specialists based on the volume of pediatric and AYA oncology patients seeking out-of-state care and survivorship support.
- Foster collaboration between pediatric and adult oncologists for coordinated adolescent and young adult care.
- Support the development of programs providing psychosocial, palliative care, and survivorship support.
- Support policies ensuring parity in reimbursement for telehealth and in-person visits, with an emphasis on expanding access to rare disease care via telehealth.
Indicators:
Number of reports assessing pediatric subspecialty needs for Nevada.
Baseline: 0
Target: 1
Number of pediatric healthcare providers, including oncologists and sub-specialists, in Nevada.
Baseline: General Pediatrics 52.2; Pediatric Sub-Specialties: 23.9
Target: General Pediatrics 57.5; Pediatric Sub-Specialties 26.3
U.S., 2022xciii: General Pediatrics 87.6; Pediatric Sub-Specialties: 45.2
Source: Nevada Physician Workforce Data Book, UNR Office of Statewide Initiatives
Percentage of pediatric and adolescent patients annually who leave the state for some or all treatment.
Baseline: 19.27%
Target: 18%
Source: NCCR
Survivorship and Support Objectives and Indicators
Objective: Increase access to psychosocial support for pediatric and AYA cancer patients, their caregivers/parents, and siblings.
Strategies:
- Promote the value of mental health support for patients and families to navigate cancer diagnoses and long-term impacts through educational materials and workshops.
- Promote psychosocial support, including one-on-one, in group settings, and clinical settings, as a standard of care from the time of diagnosis.
- Expand the geographic availability of supportive services, including mental health, nutrition support, and tele-navigation, through telehealth.
- Develop tools for healthcare administrators and decision-makers that make the case for providing supportive resources and services as a standard of care.
Objective: Increase access to formalized long-term follow-up and survivorship care for pediatric and AYA survivors.
Strategies:
- Support the development and expansion of survivorship resources tailored to pediatric and AYA survivors.
- Educate primary care providers on the survivorship needs of pediatric and AYA survivors to better support the transition to adult care.
- Promote use of the Children’s Oncology Group Passport for Care to develop follow-up screening recommendations for survivors.
Objective: Reduce the financial burden on families impacted by a pediatric or AYA cancer diagnosis.
Strategies:
- Educate families and providers about free or reduced-price drug programs and other financial resources.
- Raise awareness among Nevadans about the financial impacts of pediatric or AYA cancer to encourage solutions that reduce the burden on patients and families.
- Assist caregivers of uninsured children in applying for insurance.
- Ensure state financial resources are included in major directories like Nevada 211 and Pediatric Cancer Coalition.
- Educate payors on the needs of AYA patients.
- Support efforts to eliminate gaps in health insurance coverage for protocol services or prescribed treatments.
Indicators:
Number of psychosocial providers who provide pediatric/AYA cancer support.
Baseline: 7
Target: 10
Source: Renown, C4TK, Candlelighters, Nevada Childhood Cancer Foundation
Number of collaborative groups for pediatric cancer organizations.
Baseline: 1
Target: 1
Number of formalized long-term follow-up programs.
Baseline: 1
Target: 2
Percentage of children without health insurance.
Baseline: 7.9%
Target: 5.4%
U.S.: 5.4%
Source: US Census Bureau’s American Community Survey
Early Onset Cancers
Early Onset Cancers
Cancer is most frequently diagnosed among people ages 65-74, and the median age at diagnosis is 67, according to data from the National Cancer Institute.xciv However, some cancers are being increasingly diagnosed among young adults, such as breast and colorectal cancer. These early-onset cancers are often diagnosed at later stages in young adults than they would be for older adults, in part because younger adults are less likely to see a primary care provider unless they have symptoms and are generally not eligible for recommended cancer screenings which help to detect cancers early. Additionally, because cancer is often considered a disease of aging, it is not usually the first thing a healthcare provider may test for.
Researchers have yet to identify the exact cause of some early-onset cancers, however genetic and other risk factors may play a role. Maintaining a healthy diet that limits processed meats and alcohol, getting regular exercise, avoiding tobacco and secondhand smoke exposure, and getting vaccinated for HPV are risk reduction strategies everyone should employ, but may be helpful in avoiding early-onset cancer. Individuals should also be aware of their family history of cancer and discuss that history with their primary care provider, who may then recommend genetic counseling and/or initiating screening at a younger age.
References
lxxxviii Centers for Disease Control and Prevention. "Tracking Pediatric and Young Adult Cancers." 13 Feb. 2025, https://www.cdc.gov/national-program-cancer-registries/about/pediatric-young-adult-cancer.html.
lxxxix Nevada Cancer Incidence and Mortality Dashboard, 2022. Accessed May 19, 2025.
xc NCCR*Explorer: An interactive website for NCCR cancer statistics [Internet]. National Cancer Institute; 26 Sep. 2024. [cited 2025 May 19]. Available from: https://nccrexplorer.ccdi.cancer.gov.
xci National Cancer Institute. "Pediatric and Adolescent and Young Adult Cancer Survivorship." 2025, https://cancercontrol.cancer.gov/ocs/special-focus-areas/pediatric-adolescent-and-young-adult-survivorship.
xcii Mwalili, N., T. Griswold, et al. "Physician Workforce in Nevada." Apr. 2025.
xciii Nevada Office of Statewide Initiatives. Nevada Instant Atlas “MDs & DOs Pediatrics, General, Rate per 100,000 Population (2022).” 2025, https://med2.unr.edu/SI/CountyData/atlas.html.
xciv SEER*Explorer: Cancer Stat Facts. National Cancer Institute, 2025. https://seer.cancer.gov/statfacts/html/all.html