Neuro-Oncologist Joins UCSF Brain Tumor Center Team

This month, neuro-oncologist Jessica Schulte, MD, PhD joins the UCSF Brain Tumor Center team. Dr. Schulte specializes in treatment of adolescent and adult glioma and neurofibromatosis, with a focus on optimizing transitions of care between pediatric and adult medical care. Dr. Schulte earned her medical degree at Northwestern University, where she also researched how neurodevelopmental pathways go awry in brain cancer for her PhD. Later, she completed her residency in neurology at Columbia University, followed by a Chief Resident year. Dr. Schulte recently completed a Clinical Fellowship in Neuro-Oncology at UCSF, and will be continuing in the Department of Neurological Surgery as a Clinical Instructor.

What are some of the challenges of transitioning patients with brain tumors between pediatric and adult care?

"Traditionally, transitioning people from pediatric to adult care has a lot of logistical challenges. But beyond that, this is a time that adolescent and young adult (also called AYA) patients have a lot of unique needs. Patients in their late teenage years or early twenties are wondering about how to deal with the cognitive effects of the treatments they received for their brain tumors, in the context of finishing high school and starting college, and trying to navigate their first jobs. Others might have relationship and fertility concerns. This is all in the background of the usual leaps in autonomy and independence that every person at this age faces. There are a lot of important life events to navigate."

"This transition is a challenge not only for neuro-oncology, but across all specialties of medicine as a whole. In pediatrics care, there is a lot more support for both the patients and the families in general, so the transition to adult care can be hard. In addition, oncology patients often have a really special relationship with their oncologist, and it’s hard to trust a new team. It needs to happen at some point, since brain tumors in pediatric patients and adult patients can have different genetic features, and often have different treatment strategies. Our goal is to make the transition as smooth as possible."

What are some strategies for bridging the gap between pediatric and adult care? 

"My goal is to help optimize the transition of care for AYA neuro-oncology patients. We need more information from these patients and their caregivers on how we can better serve them. What services and support do they need? Can we put more systematic measures in place, almost like a formalized checklist with personalized follow-up guidelines for medical, social, and emotional needs? This can help to transition patients more smoothly, especially in situations like these where multiple specialists and supportive care staff like social workers are involved."

"Another aspect of care of these patients includes expanding on opportunities for clinical trial involvement. There is a lot of overlap between adult clinical trials, which often accept participants as young as 18 years old, and pediatric clinical trials, which can sometimes include participants up to 39 years of age. Physicians specializing in either pediatric or adult care may not be aware of the full range of trial options available, so there may be lot of missed opportunities there."

What are some options for community physicians seeking to transition their pediatric patients to adult care?

"The UCSF Brain Tumor Center is accepting referrals from external physicians to help transition patients to specialized care. We often receive referrals or consult requests from all over California and beyond, sometimes for patients who need active treatment, as well as for patients who are in a surveillance and maintenance phase."

"Another common reason we see referrals is for patients looking to get into clinical trials. Part of what I do is match patients with trials that are appropriate for them. We have a large palette of trials that is constantly updating across a range of observational, therapeutic, and quality of life studies. I also have a special interest in molecular diagnostics and targeted therapies, and can offer insight into the trials that are going on in that domain."

Why did you choose to specialize in neuro-oncology? 

"In this specialty, you often have to have difficult conversations about hard decisions, or sometimes end-of-life care. It is gratifying to me to help guide patients and families through all that, educate and empower them make their own decisions, and give them real-time expectations of the next steps. I went into Neuro-oncology because the patients and families are wonderful, and there is a lot we need to do as a field to improve treatment options."