Pediatric cancer treatment continues to change at an amazing rate, leading to better patient outcomes.
Many recent advances are due to the evolution of personalized medicine.
Personalized medicine is the practice of using an individual’s unique genetic profile to make decisions about disease prevention, diagnosis, and treatment.
For many, these new treatments could mean a longer, healthier life.
Dr. James Fahner, medical director of Corewell Health’s Helen DeVos Children’s Hospital charity education and wellness provider, answered some common questions and shared his vision for the future of precision medicine.
How has precision medicine evolved?
The practice of pediatric oncology has changed dramatically over the past few years, Dr. Fahner said.
“Precision medicine touches the lives of our patients and families every day,” he said.
He said his team is finding new specific targets and therapies that in some cases help avoid traditional treatments and their side effects.
“There are tumors that previously required very intensive surgery, radiation therapy or chemotherapy to help control tumor growth. And now we’re seeing select cases where precision medicine has completely changed the mode of care,” he said.
“When we’re lucky enough to find the right target and have the right ammunition, it can help us do things we’ve never been able to do before,” he said.
What can you do now that you couldn’t do before?
Dr. Fahner said the most important things are the things his team no longer needs to do.
“Whenever we can save a family time in the hospital or unnecessary treatment, we are always so grateful,” she said. “The physical cost of treating children has always been extremely high, and as pediatricians we are always aware of how fragile and vulnerable children are during these critical stages of growth and development.”
He said subjecting children to major surgery and radiation treatments, including harsh combinations of chemotherapy drugs, was something that would never have been the first choice.
“It was a therapy that worked, but it always came at a very high cost,” he said.
He noted short-term side effects such as hair loss, nausea and low blood counts, but also long-term side effects including reduced heart, lung, liver or kidney function, or equally worrying effects on learning or cognitive function.
“For us, the miracle of precision medicine is what we won’t have to do in the future.”
How have the results improved?
Dr. Fahner said childhood cancer outcomes continue to improve worldwide.
“I remember the days when many childhood cancers had only a 50:50 chance of survival or cure,” he said. “Now we have many examples of childhood cancers with 70, 80 and 90 percent cure rates. Is a miracle”.
Dr. Fahner said he believes the treatment of childhood cancer is one of the miracle stories of modern medicine. But with the caveat that it is really expensive.
“We are grateful for the high cure rates, but for many it can also mean a very long and treacherous journey of two or three years, with many hospitalizations, scans, bone marrow studies, radiation treatments, chemotherapy and more.
“If we could completely change the history of childhood cancer from the arm to a laser-focused approach … that would be our goal.”
What is one thing you thought you would never see happen during your career in medicine?
“One of the most rewarding things about our careers as oncologists is seeing our children surrounded by healthy, accomplished young adults,” said Dr. Fahner. “You see it down the road when you get invited to graduation open houses or even wedding receptions.”
She said it is extremely gratifying to see the number of patients so deeply affected by their care that they dedicate themselves to a career in pediatric cancer.
“I’ve seen many former patients become nurses, doctors or child life specialists,” she said. “All those who have once had successful journeys in treatment and want to dedicate their careers to helping children like them.”
How have patients noticed improvements and advances in care?
Dr. Fahner said one of the most interesting things he noticed was that parents reported fewer and fewer serious side effects after treatment.
“Often parents come to the clinic and say that their child had a little upset stomach after the treatment,” he said. “And in my mind, I think if it had been just a few years ago, most of these side effects would have been much more severe.
“You realize how grateful you are to have more manageable or normal experiences like an upset stomach instead of the extremes these kids were going through.”
Another truly heart-warming change in patient care, she said, is that families and clinicians can confidently make plans from the start, fully anticipating treatment.
“It’s very different from the mindset of decades ago when the forecast was holding,” he said.
Now, he said, the whole tone and delivery of care has changed.
“For example, we’ll say ‘keep up your school work because you’re going to go to college and one day you’re going to be a successful adult … who’s completely cured of this cancer,'” she said.
Dr. Fahner now expects his patients to grow up, marry, start families, and lead normal adult lives after treatment; results are less certain in previous years.
How does all this positively affect patients?
“We want to make sure our children and families get through this journey as unscathed as possible,” Dr. Fahner said.
There are many things that we cannot avoid or change, he said.
“But as much as we can, we aim to protect the child’s childhood as much as possible so that they come through this truly overwhelming and life-changing experience, ready and able to face the next chapters of their lives.”
Dr. Fahner said recently that he reflects on three decades of building the pediatric cancer program at Helen DeVos Children’s Hospital.
“And much of our program’s success comes from our emphasis on true team effort. We have our morning meeting every day and discuss treatment plans for families with particularly difficult diagnoses,” he said.
“Everyone always gathers with one goal, as a team. It is truly a miracle of multidisciplinary care, and we are grateful that all of these wonderful, dedicated team members are available to our children every day.”