Treatment, Trials Extend the Lives of Young Cancer Patients

Treatment, Trials Extend the Lives of Young Cancer Patients
Program offers continuity of care to help all pediatric cancer patients thrive into adulthood.

Childhood cancer survivorship rates increased significantly over the last four to five decades – from 10 to 85 percent, according to Vanderbilt-Ingram Cancer Center (VICC) pediatric oncologist Debra Friedman, M.D.

“There are multiple contributing factors,” said Friedman, a co-leader of the Cancer Health Outcomes and Control research program at VICC and the E. Bronson Ingram Chair in Pediatric Oncology at Vanderbilt University Medical Center.

“One is the availability of clinical trials, which are ingrained in the treatment of pediatric cancer. Thanks to the National Cancer Institute’s Children’s Oncology Group, we can take a pretty rare disease and still enroll the number of patients we need to conduct a successful clinical trial.”

About 75 percent of pediatric cancer patients will participate in a trial at some point during their treatment, she said.

“If there’s a clinical trial that’s open and offers something new, we find a way to offer that to the patient so they can get the most cutting edge treatment available.”

Reducing Treatment Toxicities

When treating cancer in children, Friedman explains, there is a much stronger emphasis on enhancing efficacy and minimizing toxicity in the child’s body, since children live with the effects of their cancer treatments for the rest of their lives. Precision cancer treatments have advanced significantly, employing less invasive drug delivery, targeting tumor genetics, and using immunotherapy to destroy cancer cells.

“We have standards based on the biology of a cancer, the patient’s age, their developmental status, their organ function, and their history of treatment,” she said. “We help parents choose what we think is going to be the best therapy for efficacy with the lowest toxicity.”

In pediatric cancer, survival is not enough, Friedman adds.

“What we really want is quality of survivorship,” she said. “Over time, we’ve seen treatments change and grow to reduce toxicities. With these changes, we’ve been able to markedly decrease the long-term morbidity and mortality related to childhood cancer treatments without adversely affecting survival.”

Long-term Survivorship Care

Beyond the impact of cancer treatment on a child, clinicians must consider the impact on the patient’s family – from parents to younger siblings.

Friedman and VICC colleagues are investigators in a broad array of studies that address such critical topics in cancer as post-traumatic stress, parenting practices during treatment, psychological adjustment in caregivers, and financial strain on families.

“We are curing more children and adults, or keeping their cancer at bay for years, but those same successes are leading to new challenges in the area of survivorship,” Friedman said.

At VICC, the REACH for Survivorship Program helps patients of all ages who have faced any type of cancer and received treatment from any health care provider.

“We’ve been able to markedly decrease the long-term morbidity and mortality related to childhood cancer treatments without adversely affecting survival.”

“Pediatric patients are going to grow into adults and will still need follow-up for long-term effects,” Friedman explained. “Why should they be transferred for care during their lifetime? Every time you have a transition in care, you risk losing a part of your story and someone not knowing what’s needed.”

The program is designed to address physical, emotional and practical patient needs.

“The clinic is not intended to take the place of oncology, but it is really focused on the education of the patient, caregiver and primary care physician,” Friedman said.

Disparities in Childhood Cancer Treatment

Reducing health disparities and increasing treatment access for all children, especially those from historically marginalized groups, is another area where pediatric cancer specialists are spearheading advancements.

“There are definitely racial, ethnic, socioeconomic and geographic disparities in the outcomes of children with cancer,” Friedman said. “Even though these patients go to the same large medical centers, and they get the same treatments, the burden of cancer on patients and families of lower socioeconomic status or families who live in rural areas is particularly heavy.”