The Journey to Holistic Care for Childhood Cancer Patients

Tanja Gruber, MD, Director of the Bass Center for Childhood Cancer and Blood Diseases at Stanford Medicine Children’s Health, and member of the Stanford Cancer Institute.

Hearing that a child is diagnosed with cancer marks the beginning of a challenging journey for thousands of families around the nation. Each year, approximately 15,000 children and adolescents younger than 20 in the United States are diagnosed with cancer.¹

Our field continues to innovate and advocate for children and adolescents—and while it is a year-round effort for us, Childhood Cancer Awareness Month is a time to put these efforts into the spotlight for the public. Raising awareness for pediatric cancer fosters support for those affected by the disease, reduces social stigma, and helps increase research and funding for more effective treatments. It is our annual reminder that children are not small adults when it comes to care. Importantly, there is work to be done to continue to advance cancer treatment.

We must focus on the following 3 areas within childhood cancer care: predisposition, holistic support, and survivorship. As oncologists and the healthcare industry advance their practices to propel care for children, it is crucial for the industry and population at large to tailor care for the unique needs of children to maximize recovery and truly help patients thrive.

Accelerate Understanding of Predisposition to Childhood Cancer

Childhood cancer is influenced by various factors, such as genetic mutations, family health history, and environmental conditions. However, most cancers develop by chance and are not hereditary—and, thankfully, most children are considered healthy. In fact, a child may be the first in their family to have a genetic alteration that puts them at higher risk of cancer. This makes preventative approaches to childhood cancer challenging.

To advance this underserved and understudied area of pediatric and childhood cancer, we must bring a programmatic approach to preventative screening and research. Much of this effort is currently centered around efforts to understand the likelihood that pediatric patients are predisposed to certain malignancies resulting from other forms of care or treatment, including immunosuppression.

Better understanding predisposition will also enable care teams to innovate treatment options sooner in the evaluation process and, importantly, bring the most promising treatment options to a wider range of patients through clinical trials. For example, we are seeing great advancements to chimeric antigen receptor (CAR) T-cell therapies, in which a patient’s own immune cells are supercharged to better recognize and attack certain cancers. At Stanford Medicine Children’s Health, CAR T-cell therapy is now being applied to brain and spinal cord tumors and solid tumors, while doctors bring new approaches to make CAR T-cell therapy in liquid tumors more effective. The sooner these malignancies can be screened for and detected, the quicker patients can benefit from these evolving cell-based therapies.

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Get Deliberate About Physiological, Psychological and Social Support

Holistic care for childhood cancer patients treats the patient as an individual, tending to emotional, psychological, social, and physiological needs. When a patient receives holistic care, it provides comprehensive support. This greatly benefits pediatric patients who are undergoing such a traumatic experience during an important developmental time in their lives. Holistic care can assist with alleviating treatment-related adverse effects, managing pain, and increasing long-term survivorship.

By incorporating multidisciplinary support and hiring a range of medical specialists along the care continuum, organizations can contribute to more diverse care teams within an oncology program. We must be deliberate about bringing specialty support into pediatric oncology, strengthening this area of care for generations of children to come. For example, we recently launched a psychology program specifically within our Bass Center for Childhood Cancer and Blood Diseases, hiring mental health specialists with plans to further grow the program to address the unique needs of our patient population. While multidisciplinary approaches to pediatric oncology are not new, it is time to more firmly integrate them into departments and as part of oncology teams. This includes mental, nutritional, and lifestyle treatments, and psychotherapy to care for the whole patient.

Reimagine Survivorship and Care Transition Into Adulthood

One of the greatest challenges of childhood cancer survivors is adapting to adulthood. While the 5-year survival rate for pediatric cancer patients has reached 83% to 88%, the lingering psychological or physical challenges may result in long-term detrimental emotional impacts, difficulty returning to school or work, or challenges adapting to life posttreatment.²

To combat this, we must develop new approaches ensuring that patients can survive and thrive through treatment into survivorship and beyond. A large part of this equation is securely transferring patient history, medical information, and other care notes as individuals move from pediatric to adult care. Getting this equation right smooths the overall transitional process and allows medical professionals to more accurately cater treatments to individual patients.

For example, we have piloted a new clinic for adult survivors of childhood leukemia. The GREAT Survivorship Clinic, standing for “Getting Regular Evaluations After Treatment,” is a collaboration between pediatric oncologists and adult oncologists at Stanford Medicine with the goal of providing a smooth handoff between pediatric and adult survivorship by emphasizing patient communication, as well as the connections between families and caregivers. The customizable survivorship care serves as an extension of patients’ cancer treatment and emphasizes the importance of continuously tending to physical and emotional health.

This is an area of focus that we expect to see across the industry, especially for organizations that may not have dedicated pediatric and adult care facilities.

The Road Ahead

As the fight against childhood cancer continues, the focus on multidisciplinary and comprehensive care remains essential, with children’s unique needs at the center of all efforts.

By acknowledging predisposition factors, incorporating holistic care, and assisting with transitions into survivorship, we can ensure that childhood cancer patients not only survive, but thrive in the future.

REFERENCES:

1. Tracking pediatric and young adult cancers. CDC. Published February 27, 2024. Accessed September 6, 2024. https://tinyurl.com/56zf8pst

2. September is childhood cancer awareness month. American Association for Cancer Research. Accessed September 6, 2024. https://tinyurl.com/2pp98a56