September is Childhood Cancer Awareness Month, and Dr. Jeff Hord, medical director of Akron Children’s Showers Center for Childhood Cancer and Blood Disorders, used the opportunity to discuss with Ray Horner, of WAKR AM Radio, the advances made in childhood cancer outcomes. Here are the highlights of their conversation:
Horner: I’ve been doing some reading about childhood cancer, where we are in this fight. We’re lucky in the greater Akron area to have Akron Children’s Hospital, which is helping fight cancer on a daily basis with the Showers Family Center for Childhood Cancer and Blood Disorders. How prevalent is childhood cancer?
Dr. Hord: Thanks for having me, Ray. September is Childhood Cancer Awareness Month and so we do want to get the word out that members of our community are affected by childhood cancer. We see at Akron Children’s about 2 new cases per week, on average, from our region. Nationally, there are about 16,000 cases diagnosed annually and, of course, childhood cancer isn’t just one thing. It’s a multitude of different diseases, and, while the incidence is slowly creeping up, the survival rates are really very, very good. In the last 50 to 60 years, we’ve gone from a long-term survival rate of what was maybe 15 percent around 1970 to today where it’s approaching 90 percent. So, the state, overall, for treatment and outcome is good. There is a bit of a concern, obviously, that we see just a slight creep up in the incidence rate.
Horner: When we talk about cancers in adults, a lot of it comes back to lifestyle choices. What does research tell you about why we have seen an uptick in childhood cancer?
Dr. Hord: So, in fact, it’s not lifestyle choices in pediatrics. It’s not likely to be a much in the way of exposures. It’s really related to a chance coincidence of when cells are multiplying, dividing and turning over that genetic mistakes occur. The vast majority of times those mistakes are corrected, or it causes the cell to die. But every so often the cells become more aggressive and that becomes cancer. The rate is something like a .5 to 1 percent increase every couple of years. It’s a very small rate and often it’s seen with brain tumors – the most common solid tumor we see in children – but the exact reason for the increase we’re not entirely sure.
Horner: Let’s talk about treatments for kids with cancer.
Dr. Hord: The traditional treatment for cancer has been a combination of different drugs, referred to as chemotherapy, and it’s still the mainstay of what we do. There are certain tumors and situations where radiation therapy may be beneficial, but we use that sparingly because of the damaging effects radiation can have on development of a young child. Surgery is certainly a key component, so in many types of solid tumors we want to take the tumor out when at all possible. But on the “advances” side, we’ve seen a remarkable increase in the use of immunotherapy, which are ways to trigger our own immune system to fight the cancer. It can be quite effective, and we’re still learning a lot about it. But the harmful side effects associated with immunotherapy can be a lot less than what can sometimes be seen with harsh chemotherapy.
With survivorship at 90 percent, we have a comprehensive survivorship clinic at Akron Children’s. This is a specialized team looking at our cancer survivors on a regular basis to look for any of those side effects – or late effects – that can sometimes occur because of the treatment that the child received earlier. We want to pick up those problems early and intervene early, which will give the best long-term outcome.
Horner: Again, when we talk about cancer in adults, we talk about early detection, whether it be a mammogram a colonoscopy. But how does early detection look when we are talking about childhood cancer?
Dr. Hord: There are certain types of genetic syndromes, where there’s a predisposition or a tendency toward developing certain cancers and so patients diagnosed with these genetic problems are screened. We are screening and looking for certain types of tumors on a regular basis to try to pick them up early because that’s a very small percentage of all the cases that we see. Generally, it’s more about the inherent biology of that tumor itself and how aggressive it’s going to be. If a child presents to us, and we find that it is widespread or at a high stage, that probably doesn’t have a lot to do with how long it’s been there but probably has to do with the overall inherent aggressive nature of that particular tumor. We see other children who may have had a lump or bump that’s been there for a very long time and it’s very localized, very low stage, but it’s just that inherent biology of that particular kind of cancer – that it’s just not going to spread.
Horner: Parents know their kids better than anyone else so if they see a change in health, they typically know when to call the doctor.
Dr. Hord: Absolutely, you know we almost always end up finding a child with cancer because they’ve been brought to the emergency room or to their primary care physician by the parent. The parent has noticed something different – maybe the abdomen seems a little bit thicker or maybe the child is not walking quite right or they’re seeing more bruises than usual. So, it’s those types of symptoms that parents pick up on first that brings the patient to us and then the ultimate diagnosis.
Horner: Let’s wrap up by talking about the Showers Center for Childhood Cancer and Blood Disorders.
Dr. Hord: I’m very proud of the team that we have at Akron Children’s. We have about 120 or so staff members who are really focused on taking care of children with a variety of types of childhood cancer and blood disorders. We have a team of specialized physicians, for example, those with specific experience in brain tumors, a bone marrow transplant team, a team specific to child survivorship, as I mentioned. But I’m very proud of the resources and services we’re able to provide thanks to the community support provided us and to patients and families on this very difficult journey. So, we have school teachers, outreach educators, psychologists, social workers, child life specialists, and a variety of staff members to help the family during a very, very difficult time. We want to bring some normalcy to our patients’ day-to-day lives, and, when treatment is over, we hope that they are able to go right back into the same classroom, with those same peers, and pick up where they left off.