Fifth Issue, Series Three
Pediatric Cancer CareThere is nothing that pulls at my heart strings more than the sight of a young child dealing with a diagnosis of cancer. This issue of Conquering the Cancer Care Continuum™ focuses on pediatric cancer care, a challenging area of oncology management, but one in which amazing progress is being made. As discussed in the oncology pharmacist perspective, 2 important trends are paving the way for improved clinical outcomes in children with cancer. These are the identification of genetic polymorphisms that affect the way in which patients metabolize certain drugs, and an increase in pharmacogenomic screening, which can be used to identify driver mutations that are likely to respond to specific therapies. The oncology nurse perspective provides a brief history of pediatric oncology, including the high mortality rates that were so common decades ago, and explores promising advances in treatment. Finally, the physician perspective discusses effective strategies for curing cancer in more children in low- and middle-income countries. Although certainly there are still children and teenagers dying from specific malignancies, fortunately, there are more surviving than ever before. In fact, the very high survival rate in pediatric leukemia is probably the greatest success story in the field of hematology/oncology. With the availability of targeted therapies, we have entered a new era that provides hope for children diagnosed with other types of cancer. However, along with our ability to save more young patients, we are faced with ongoing challenges that need to be addressed, including lingering adverse events and late effects of treatment. Unfortunately, we are uncertain as to what the late effects of some treatments will be, as they have been used in practice for a relatively short period of time. We are also witnessing an increase in the availability of clinical trials for children with cancer, which is very good news. Children who have achieved remission are typically monitored by pediatric oncology survivorship clinics. A great deal has been learned through this follow-up, which goes on for many decades after treatment. This will remain an important strategy as new drugs and combination regimens continue to be integrated into the treatment paradigm. Clinical trials of various approaches to survivorship management will also be highly important. As you read this issue, you will have the opportunity to consider what the experience is like for a young patient coping with cancer treatment. Hair loss is perhaps the most obvious sign to a child that something very serious is happening inside of his or her body. Although individuals are often focused on the immediate effects of treatment, pediatric oncologists must look beyond the present and consider future life goals of their patients. For example, there is a need for timely fertility preservation (even for patients in their late 30s and early 40s); limited use of drugs that cause peripheral neuropathy, which may interfere with career goals; and treatments that prevent the body from rapidly aging, which occurs when a person’s body is stripped of its sex hormones. And there is that gray area in which young adults are diagnosed with a childhood cancer and need to decide if they will be managed by a pediatric oncologist or an adult oncologist. That is all the more reason for those of us who are oncology providers to look beyond the pathology of our patients and factor into the treatment plan their known or likely life goals. We can apply much of what we learn from pediatric oncology survivors to adult survivors, recognizing that adults are living longer—many decades after their treatment was completed. My hope is that the concepts discussed in this issue will help you in the care of your patients with cancer regardless of their age.
Cure rates for children with cancer now exceed 80% in high-income countries (HIC), but several challenges remain.1 Curing the remaining 20% requires new drugs, better combination regimens, and improved risk stratification to avoid undertreatment, and the 80% who are event-free survivors after frontline therapy often must deal with significant late [ Read More ]
As a practitioner in adult oncology, it is only on rare occasions that I see pediatric patients managed in our clinic. Generally speaking, such patients seen in this setting are mid-adolescents with diagnoses of Hodgkin lymphoma who are being treated with a standard adult regimen. These patients are presented with [ Read More ]