Kate Middleton and a Cancer Diagnosis

The celebrity of the British royal family is a global phenomenon. Most recently, people worldwide were watching as something rather mysterious and unconventional happened within the royal family, specifically around Kate Middleton. From conspiracy theories about Kate Middleton being alive (or not) to the photoshopped Mother’s Day photo (for which Kate took full responsibility), watching events unfold was perplexing, leaving us with more questions than answers. It eventually became evident that the gaslighting was an attempt to buy time before the royal family publicly revealed very private news: Kate Middleton has cancer.

Kate Middleton addressed the situation in an eloquent video, in which she was seated on a bench in front of a garden of daffodils. Coincidently, or maybe intentionally, daffodils symbolize rebirth, new beginnings, joy, hope, and good luck, which all makes sense amid a cancer diagnosis.

Young Adults With Cancer

A cancer diagnosis for a young adult (under the age of 50) is more shocking than for their older counterparts. The diagnosis is disruptive to their physical, emotional, and mental health and the ability to consider the future with ease and clarity. Many young adults with cancer have young families that need tending to as well as age-appropriate explanations. Now add the pressure of being a public figure subjected to having your every action scrutinized for meaning.

Compassion for Kate Middleton

This is the situation in which Kate Middleton and her family have found themselves: processing a devastating cancer diagnosis in private with their family and chosen close circle. What someone shares related to their health, and how they choose to share it, is very personal and should be determined by the person who has been diagnosed. I wonder about Kate Middleton’s ability to make these choices. It seems to me, she was robbed of that choice by an unfair chain of events and public pressure.

Kensington Palace released a statement to address speculation and insensitive comments and theories surrounding Kate Middleton’s health, stating, “The Princess is now on a recovery pathway having commenced a course of preventive chemotherapy.” While the precise diagnosis is unknown, we do know that she had abdominal surgery with quite a lengthy recovery. The surgery was originally thought to be a successful removal of something noncancerous; the cancer diagnosis was later revealed. Her medical team prescribed chemotherapy as a preventive measure. The rationale behind this type of treatment, despite successful surgical removal, is to target and destroy any cancerous cells that may be left behind before they can spread to distant areas of the body. The hope is that with a combination of surgery and preventive chemotherapy, the risk of the cancer coming back and/or spreading will be greatly reduced if not eliminated.

Preventive Chemotherapy

Both Kensington Palace and Kate Middleton have used the term preventive chemotherapy, which is not necessarily a common term in oncology. Oddly enough, according to the World Health Organization, preventive chemotherapy is used to treat “neglected tropical diseases.”¹ The treatment Kate Middleton is likely receiving is called adjuvant chemotherapy. This type of treatment follows successful surgery to target cancerous/precancerous cells at a microscopic level and prevent progression or future relapse of disease. Physicians and healthcare professionals take an oath to “do no harm” so that the benefits of treatment outweigh the risks. In Kate Middleton’s case, as well as with many young adults with cancer, the benefits of longevity and health outweigh the acute effects of adjuvant chemotherapy.²

Good Prognoses Despite More Diagnoses

For young adults diagnosed with cancer, the possibility of living a long, fulfilling life is becoming more and more common. As treatments advance and early detection identifies cancers at more treatable stages, the possibility of surviving cancer increases. According to the National Cancer Institute, when all cancer types are combined, the overall survival rate for adolescents and young adults (AYAs) with cancer is 86%.²

Young adults are surviving longer after a cancer diagnosis, but they are also being diagnosed at alarming rates in recent years. While overall the AYA cancer incidence is about 4% of all cancer diagnoses, or 89,000 new cases per year, the rate of diagnosis is rapidly rising for AYAs. The increased diagnosis rate is likely due to multiple factors: early detection, diagnostic abilities, screening campaigns and awareness, as well as environmental exposure/factors, genetics, and lifestyle factors. Likely there are additional reasons, compounding this issue, that are not fully understood or identified.

Many prominent younger adults have publicly announced a cancer diagnosis, either on their own terms or by public demand. Some of these include Olivia Munn; Michael Strahan’s daughter, Isabella; the late Tom Parker (from The Wanted); and Suleika Jaouad. Other, not so recent, young celebrities diagnosed with cancer include comedian Tom Green, cyclist Lance Armstrong, Bob Marley, Ethan Zohn, and many more. While the phenomenon is not exactly new, the incidence rate is increasing. According to Koh and colleagues,³ it appears that the incidence rates for young adults are on the rise at the same time incidence rates for older adults are declining, indicating a reversal in the incidence curves/rates for the 2 populations.

AYAs as a Special Population

AYAs are considered their own distinct population in contrast to pediatric and older adult counterparts due to the many unique factors and barriers to care AYAs face when diagnosed with cancer. AYAs have a distinctive set of cancer diagnoses, including breast cancer, colon cancer, thyroid cancer, testicular cancer, and melanoma.² The characteristics of AYA cancers lend themselves to more aggressive forms, specifically noticed in breast cancer and colorectal and other gastrointestinal cancers when diagnosed at a younger age.⁴

Within the young adult population there is variation in diagnoses. For those aged 15 to 19 years, the most common types of cancer are testicular, Hodgkin lymphoma, thyroid, brain, and central nervous system tumors. For 20- to 29-year-olds, the most common cancer types are testicular, thyroid, breast, and melanoma. For the older portion of young adults, aged 30 to 39 years, the most common forms of cancer are breast, thyroid, testicular, and cervical.2 While these are the most common cancers for the age ranges within the AYA population, there are other cancer types seen in the AYA population that are often found in older adults or young children.

Cancer is known as a disease of the old or aging, not the young. Young adults often present with symptoms that are nondescript and general, which are often dismissed for some critical period of time. Anecdotally, many young adults have reported that they were either misdiagnosed, their symptoms and concerns were dismissed, or they didn’t think anything of their symptom(s) and delayed visiting a healthcare practice. It is undoubtedly shocking for anyone to hear “You have cancer,” but it is even more so for those between 15 and 39 years old.

Take a moment, regardless of your age, to think about who you were and what was going on in your life when you were 18, 25, or 35. Within the AYA population, the profound implications of a cancer diagnosis are undeniable. The biggest issues, or barriers to care, for young adults include social isolation, financial toxicity, fertility preservation, survivorship, and mental health. All of these aforementioned barriers can exist simultaneously, overlap, and ebb and flow throughout the cancer journey. Additionally, what one young adult finds supportive or helpful in alleviating barriers to care may not translate to another young adult.

Facing Cancer as a Young Adult Has Unique Challenges

For young adults facing cancer, if their psychosocial needs are addressed adequately, their compliance to treatment increases and treatment outcome improves.5 Social determinants of health are also predictors of adherence and can contribute to the stressors patients and their loved ones face. For example, housing issues such as rent and utilities and transportation issues such as car payments, insurance costs, fuel costs, tolls, parking, etc, all exacerbate the financial burden experienced in addition to the cost of healthcare. The out-of-pocket costs and expenses related to cancer treatment tend to be high for young adults. And, unfortunately, young adults typically do not have the financial means to cover the costs due to low-paying entry level jobs, little financial security, and being either uninsured or underinsured.

Illuminating a Global Issue

The good news is that celebrities who have been diagnosed with cancer as a young adult and choose to share their story help to illuminate this rising global issue. Kate Middleton’s decision to share her cancer diagnosis publicly was likely expedited by the pressure of being a public figure (and maybe by the outlandish stories circulating on social media), but her platform can help to illuminate the unique needs of young adults facing cancer.

Behind the scenes, Kate Middleton, like any parent, was likely concerned about telling her young children about her diagnosis in an age-appropriate manner. She, too, was processing and coping with the unfathomable at a mere 42 years old. Kate Middleton’s startling diagnosis teaches us that no matter your social status, financial situation, or overall health, cancer does not discriminate.

References

1. World Health Organization. Preventive chemotherapy. Accessed May 15, 2024. www.who.int/teams/control-of-neglected-tropical-diseases/interventions/strategies/preventive-chemotherapy
2. National Cancer Institute. Adolescents and young adults with cancer. Updated April 26, 2024. Accessed May 15, 2024. www.cancer.gov/types/aya
3. Koh B, Tan DJH, Ng CH, et al. Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019. JAMA Netw Open. 2023;6:e2328171.
4. Dharwadkar P, Zaki TA, Murphy CC. Colorectal cancer in younger adults. Hematol Oncol Clin North Am. 2022;36:449-470.
5. Trevino MK, Fasciano K, Prigerson HG. Patient-oncologist alliance, psychosocial well-being, and treatment adherence among young adults with advanced cancer. J Clin Oncol. 2013;31:1683-1689.