Jaime Lewis (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical conditions and build a healthier future.

Today, I'm sitting down with pediatric hematologist and oncologist, Dr. Christine Bolen, and we're going to be talking about the impact that a pediatric cancer diagnosis has on a family plus new hope for patients. Before we get started, I'd love to know how this became a passion of yours, Dr. Bolen. What made you decide to become a pediatric hematologist and oncologist?

Christine Bolen, MD: Thank you. I would say that the moment that I knew that this is what I wanted to do was based upon when I was a young child, I actually didn't know these children well, but there were twins. And every week they were in my church sitting in the same bench together. And then, one day one of the twins shows up and she doesn't have any hair. And so, I said to my mom, "Does she have cancer?" My mom said, "Yes, I believe she has cancer." And so, it just made me start thinking about how cancer can affect anyone of any age at any time.

And then, one day, there was only one twin sitting there, so that child had passed. For me, even though I didn't know that child, I didn't have a relationship with them, it was children that I had seen throughout my lifetime consistently, and I just couldn't get over the fact how someone could be so healthy and seemingly so happy and in, you know, a great part of their life, and then they're lost, and how tragic that was. And so, that was my impetus ever since then. I've been so interested in Medicine, science, and you know, what can we do for these children?

Host: It's so interesting how those stories have their origins and things that are very authentic and real in our past. And so, I really appreciate that. And as you talk, I'm reminded how heavy a topic pediatric cancer is. Can you share some of the statistics, make it real for us, how many new cancer diagnoses are there for children each year?

Christine Bolen, MD: Yeah. So for pediatrics, there's almost 16,000 children a year diagnosed with childhood cancer. You know, we've made a lot of strides in the last few decades. At this point now, we quote that 85% of children are still surviving at five years from their initial diagnosis, but that's 15 percent that are not, and that's not good enough.

Host: How does a new pediatric cancer diagnosis create a ripple effect across a family?

Christine Bolen, MD: A new diagnosis for a family, there's usually this moment of disbelief. It tends to be the healthiest child in the family. And so, there's this pause of, you know, do you have this right? You know, is this accurate? Does my child really have cancer? And then, with that, a lot of times parents will go back and think about, "Well, what did I do? Or what could I have done? Or how come this didn't come to my attention earlier?" And genuinely, usually, there's nothing that they could have done differently. Cancer, unfortunately, happens. And so, what we need to do is to not look back, but try to think about where we are now and move forward with hope.

Host: As you mentioned, there's an 85% survival rate after five years of diagnosis. How has that changed over the years? How has treatment for pediatric cancer shifted maybe in the last 10 to 15 years?

Christine Bolen, MD: Sure. So, the survival rates, perhaps about five to ten years ago, we would have said 80%. So, there's been, overall, a continued improvement in survivorship for these children with cancer. But, despite that, we know that even if you're a childhood cancer survivor, there can be some long-term effects of the therapy. And so, treatment has shifted in many different ways. One of the goals is try to continue to improve outcomes because we're not going to be happy until 100% of these children are cured.

But the second part of treatment is shifting things to try to provide equally, if not superior outcomes, but with less long-term toxicity. And so, most of the clinical research trials and goals have been to improve outcomes and reduce toxicity. And fortunately, we have been blessed with having additional opportunity to incorporate medicines other than chemotherapy into the treatment. So, we now have what we call molecularly targeted agents. So, we look at the pathways that are driving the cancer and we found medications that target those pathways to slow and halt the growth of the cancer cells. We also now have opportunity to provide immune therapy to many different cancers. So, this is utilizing the support of your own immune system and drugs that attack, what we say markers on cancer cells, for example, to specifically target and attack those cancer cells.

So in addition to chemotherapy, we have molecularly targeted therapy, we have immunotherapy. And additionally, there's still a role for surgery, absolutely, but we have less invasive surgical options now that we never had before with all this robotic technology. And then, we have radiation therapy, which has advanced so much in the last 20 years, we used to get a lot of scatter and hit healthy organs, but now it's becoming more and more refined to target the tumor itself.

Host: Maybe talk a little bit more about that. What kind of advances do you see coming in the near future that will have a direct impact on pediatric cancer outcomes?

Christine Bolen, MD: Sure. So, pediatric acute lymphoblastic leukemia is the most common type of childhood cancer. And with the addition of immune therapy, we've been able to replace some of the more toxic chemotherapy cycles with immune therapy. And that has really reduced the risk of life threatening infections and improved survival from that may have been altered based upon toxicities from treatment. And even with recent clinical trials showing that actually we've improved survivorship in a certain population by almost 10% with addition of immune therapy and reduced toxicity. So, I think the future of pediatric cancer is going to be to continue to shift to immune therapy as a replacement for more toxic chemotherapy.

Host: Excellent. Well, for a family that faces new life-altering diagnosis of cancer, what resources are available to them to help navigate this new normal?

Christine Bolen, MD: As part of most comprehensive pediatric cancer centers, we have the support of social work. They're integrally involved with families, usually with a family, if both parents are working, one of them generally has to stop working and commit themselves fully to the care of that child. And the other parent, if they're still working, needs to have some more flexibility in their schedule. So, social work has been critical to working with different charitable organizations to help support families with their mortgage, their car payments, being able to maintain their job even if it's more limited, child care for the other children. So, social work plays a critical role.

We additionally have child-life specialists. And so, they work with children who are coping with cancer, but not just the child, but also with the parents on what the parent's perspective is. And you know, what are they coping well with? What are they not coping well with? How can we approach things differently to try to improve their day to day in our office? And then, of course, we have access to spiritual chaplains to offer support for the family.

One of the things that I really encourage families is generally when there's a diagnosis of pediatric cancer, a number of friends and family reach out and say, "What can I do? I want to help you. What can I do?" And many times, there's this, "Oh, I got it. We're okay. We don't need anything." But these people, the community, they want to help, so it's okay to ask for their help, to give them specific things. "My child really could use some button up pajamas, because that helps with access to the central line when they're in the hospital." It can be even the little things, or "My other child has gymnastics. Is there someone that could take them to gymnastics when I'm in the clinic my child who has cancer?" And so, really accepting support from family and friends and community.

Host: Well, thank you, Dr. Bolen, for all this really critical information for the important work that you do.

Christine Bolen, MD: You're welcome.

Host: Once again, that was Dr. Christine Bolen. To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, visit healthyheadlines.Org. Thank you for joining us.