Both the American Academy of Pediatrics (AAP) and the National Cancer Institute recommend that children and adolescents receive diagnosis, staging and treatment at one of the more than two hundred medical centers that specialize in pediatric cancers. According to several studies, young patients’ survival rates are 20 to 40 percent higher when their care is coordinated by pediatric oncologists and is carried out at comprehensive, multidisciplinary cancer centers.
The term multidisciplinary means that although your child will have one or possibly two attending physicians orchestrating her care, her case will be reviewed by specialists in various treatment disciplines. In this comprehensive approach, the health-care team might consist of a pediatric surgeon; a pediatric oncologist, or chemotherapist; a radiation oncologist; a pathologist; and other specialists as needed.
Increasingly, cancer therapy incorporates several modalities, in an effort to improve not only the cure rates but patients’ quality of life. It is now routine to follow many surgeries with chemotherapy or radiation therapy—sometimes both—to treat any remaining tumor cells (whether visible or not) and seek to prevent a future return of the disease, or relapse. Another trend in cancer medicine is to administer these treatments preoperatively; perhaps to whittle a previously inoperable tumor to a surgically resectable size or to spare a patient from having to undergo an amputation or other mutilating surgery. With so many variables in terms of sequencing treatment, it is essential that all the specialists be assembled at the time of diagnosis. This occurs in a multidisciplinary cancer center. A team of specialists reaches a consensus on what it believes is the most appropriate course of treatment, or protocol, for your child.
What Are Clinical Trials?
For all the progress made in cancer treatment, there is still a long way to go. It is through conducting clinical trials that new drugs, improved methods of delivering radiation, and multimodality protocols find their way into practice. About seven in ten children who are treated at pediatric cancer centers participate in investigational studies. They receive treatments that earlier studies have found to be effective and that researchers believe will prove superior to existing therapies. These are usually modifications of standard treatments, so there is little risk of receiving inferior therapy. In what’s called a phase 2 clinical trial, the new treatment is given to a large group of similarly diagnosed patients (the study group), while another large group with the same disease (the control group) receives the current standard treatment. The National Cancer Institute is involved with these drugs at all levels of development, before approval is given.
One other consideration when deciding on a treatment center: As parents of a child with a potentially life-threatening illness, you’re seeking not only medical expertise but experience in treating young cancer patients. Dr. Gerald Gilchrist, a pediatric hematologist-oncologist at the Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, observes, “With teenagers, the emotional and developmental issues that come up in the course of a catastrophic disease are very different from the issues adults often face. The average internist or oncologist is not trained to deal with these issues and may not be comfortable dealing with them.”
At a multidisciplinary pediatric cancer center, it is understood that quality cancer care encompasses the whole patient; maintaining his sense of wellbeing as well as his physical health. The medical team routinely includes an oncology social worker sensitive to the concerns and anxieties of adolescents diagnosed with cancer.