Managing Childhood Cancer Treatment’s Late Effects

For a child diagnosed with cancer, cure is the ultimate goal. However, as modern medicine pushes survival rates higher than ever before, the medical community is facing a new, lifelong challenge: managing the late effects of the very treatments that saved these young lives.

CURE spoke with Dr. Will Parsons, Chief of the Division of Hematology-Oncology at Baylor College of Medicine and Director of Texas Children’s Cancer and Hematology Center. Parsons discussed how the field is evolving beyond acute treatment to focus on decades of health.

From developing targeted, less toxic molecular therapies to the complexities of transitioning patients from pediatric to adult care, Parsons highlighted the innovative strategies being used today.

Transcript

With Texas Children’s having a massive survivor population, as treatments become more successful how is Texas Children’s evolving to address long-term side effects associated with modern therapies?

When we spend a couple of years treating a child with acute leukemia who's 5 years old, after we cure them our goal is for them to have a healthy, productive, happy life for another 80 years, a long time. There are now hundreds of thousands of childhood cancer survivors in the United States alone, some large fraction of them have some morbidities related to their treatment — whether it was their surgery, their radiation therapy, side effects of chemotherapy — that caused some chronic challenges for them.

So here, our strategy is kind of two-fold. One is developing new drugs, new immune-based therapies, other advanced treatments, molecular treatments that target, in theory, a specific abnormality in the tumor that should not be as toxic to the patient more generally. So, trying to develop new treatments, safer treatments, run trials of those to make things better in terms of risks.

We have an incredibly thorough and large long-term survivorship clinic here at Texas Children's Hospital, the patients as they go through their treatment, and for some time after, are cared for by a primary team of nurses and oncologists who have been responsible for their treatment throughout. At some point after that, depending on the diagnosis, they get transitioned over to our long-term survivor clinic, and it's a group of oncologists and experts who are specifically focused on understanding what those long-term risks might be related to specific treatments, because it's different depending on what the child has actually gone through, and how to know how to most effectively and proactively screen and watch for any challenges that might come up, and then treat them from there.

There are a lot of different ways that this is done. A particular challenge is the transition from childhood to adult care. When we're kids we're lucky, we have our pediatricians and we're cared for in that format. I know personally, once we become young adults, our parents aren't there to help us and advise us, we go off their insurance, we are young adults that may or may not have their health at the top of mind.

There are practical challenges, such as transitioning information, for example, for our patients, from the childhood cancer doctors who took care of them to some adult expert who's going to be taking care of them when they're 35 or 55.

One thing that our team has worked on for many years that's utilized pretty broadly is Passport For Care, or PFC, which is a web-based interface and database that can be used to for each individual patient to track what treatment they had as a child, but then also incorporate and bring in the latest data about what the surveillance recommendations are for someone who has had cranial spinal radiation therapy or who has had doxorubicin as part of their treatment, which is a particular drug that has risk for long-term cardiac and heart function.

The idea being that they can be entered into a database, it can be made accessible to clinicians who are taking care of them in the future, and then it's something that from a clinician's standpoint, not just having the data, but actually what the recommendations would be in terms of the various oncology groups saying what follow up patients should have if they've had particular treatments, and how to manage them, to try to share the information, make it as streamlined as possible.

That's actually a program that was initially rolled out here at Texas Children's quite some time ago and then expanded to other sites through the Children's Oncology Group, which is the NCI-funded collaborative group that almost primarily, leads research for children with cancer, and was supported in large part at some point by the Cancer Prevention Research Institute of Texas, which is an incredible resource for us.

So, we have a lot of focus on trying to help transition both from the acute care phase to the after times, which are just as important, and transition to adult from pediatric care, and it's a real challenge. This is something that, over time, has become a primary area of focus and interest for us as it gets even more important.

Transcript has been edited for clarity and conciseness.

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