Melanie Cole, MS (Host): Welcome to Flourish, a Prisma Health podcast. I'm Melanie Cole. And today, we're talking about childhood cancer and health disparities. Joining me is Dr. Anna Hoppman. She's a pediatric hematologist-oncologist at Prisma Health. Dr. Hoppman, thank you so much for joining us today. As we talk about this topic, which is not always easy to talk about or hear about, it's every parent's worst nightmare, how is childhood cancer different from adult cancer? And what should South Carolina families understand about that difference?

Dr. Anna Hoppman: Thank you, Melanie. I'm happy to be here today. One of the main differences between childhood cancer and adult-onset cancers is that you cannot screen for or prevent childhood cancers. We think about screenings for adult-onset cancers, for example, mammography for breast cancer or colonoscopy for colon cancer, but there are no known ways to screen for or prevent cancer in children.

Melanie Cole, MS: That's an interesting distinction. Thank you for clarifying that. Now, what kinds of cancers are we talking about?

Dr. Anna Hoppman: The most common types of cancers in children are leukemias, lymphomas, and brain tumors.

Melanie Cole, MS: Tell us a little bit about survival rates for childhood cancer. Are they improving? And if so, what factors are we looking at that could be driving that progress?

Dr. Anna Hoppman: Thankfully, we've seen tremendous improvement in childhood cancer survival over time. When you look back, you know, 50, 60 years ago, there was a very dismal prognosis for childhood cancers and many children did not survive. But through incremental improvements in our treatments and the ways we support children during cancer treatments, those cure rates have risen dramatically. For some of the most common types of cancers, including acute lymphoblastic leukemia, the cure rate is over 90% today, and we're very grateful for those advancements.

Melanie Cole, MS: That's such a hopeful statistic, Dr. Hoppman. Thank you for sharing that. Now, do children in South Carolina experience disparities in cancer outcomes? And what are some of the biggest reasons behind those gaps? Explain a little bit about what disparities mean and why there are those gaps.

Dr. Anna Hoppman: Disparities means differences. So, it could be differences in the number of cancer cases, differences in the survival over time, or differences in access to certain resources or care. In South Carolina and in the United States as a whole, there's a higher incidence of cancer in non-Hispanic White children, meaning they're more likely to have childhood cancer. But there are lower survival rates among non-Hispanic, Black children, meaning if they get childhood cancer, they have lower odds of surviving compared to other races and ethnicities

Melanie Cole, MS: Well, Dr. Hoppman, based on these disparities or differences, how do those factors, like where a family lives, their income, or access to transportation, impact a child's ability to receive that timely, high-quality cancer care?

Dr. Anna Hoppman: So, cancer care, depending on the type of cancer, can be a long treatment journey, kind of ranging from months to years. For acute lymphoblastic leukemia, one of our most common types of cancer, the treatment is around two and a half years. And so when families face challenges with things like transportation, with their insurance continuity, it places this repetitive burden on the patient and the family over time because the treatment is so long. And it can make it difficult to get the treatment and services they need.

Melanie Cole, MS: While you're talking about that then, can you expand on some of those challenges that families and caregivers face? So, you mentioned transportation and certainly insurance and finances and dealing with all the red tape of insurance, that is just a dizzying situation for families. But when we think of medically and emotionally—and medically, even understanding what you're saying, what the doctors are saying, what the treatment involves, what the side effects and complications could be, and then the emotional toll that it's going to take on the family, the child, the parents, any outside family community. I mean, it can really spread out pretty far and wide when a child is suffering from cancer. So, speak about what you see, Dr. Hoppman, and really how you help families in that way.

Dr. Anna Hoppman: I think one of the things that makes our field very gratifying to work in, though it can be challenging at times or emotionally challenging for us even as the clinicians, one of the most gratifying things is the resilience of the patients and families that amidst this diagnosis or amidst the challenges with treatment, that they're very resilient. That the kids are bright and cheerful and playing games in our clinic even when we can tell that they don't feel their best.

And I think it's really that resiliency of the family and the people around the family and the neighborhood and the community that lift our patients and families up to get them through these long durations of cancer treatment and allows them to get the medical care they need.

Melanie Cole, MS: Well, it certainly is community-wide and felt by the friends and the schools and everybody when a child is going through these kinds of treatment, which can be brutal. So, South Carolina's developing a comprehensive pediatric cancer plan. What does that mean, Dr. Hoppman? And how could it improve care for children across the state?

Dr. Anna Hoppman: When you look around the United States, all states and territories develop comprehensive cancer control plans. And it's a roadmap for that state to look at their cancer statistics and see where things are going well, what they can improve over time to make things even better. But what we don't like about this is that only about 30% of plans include children with a dedicated section.

We started talking to public health leaders and cancer coalition members in the state of South Carolina, and everybody was united in this vision that we should elevate the issues of children with cancer and their families to the highest level in South Carolina and give them a dedicated section in our comprehensive cancer plan.

For us, the comprehensive cancer plan will have four areas that we'll focus on over a five-year period. They include pediatric cancer awareness, quality care, ensuring we have all the needed services and support right here in South Carolina, educational support to make sure our patients, who are also students, many of them in elementary, middle, and high school, have the support they need to be in the classroom when it's safe or remote learning during treatment.

And the final section of the cancer plan is survivorship to maintain support for our patients and families in that long period of survivorship after pediatric cancer treatment and to make sure they have the support they need, both medically and in terms of their vocational support. That if they have some late effects or challenges after cancer treatment, that we help them to find resources for vocational support in addition to their medical care

Melanie Cole, MS: What a great initiative that is. Dr. Hoppman, thank you for sharing that with us. And as we get ready to wrap up, what kinds of experiences, challenges, or ideas do you think, and in your vast experience, would be most helpful for parents and caregivers to share as we build this plan? What would you like to hear from them?

Dr. Anna Hoppman: The state plan is for them and is informed by them. You know, we care for these patients every day and their families, and we listen to them, to what's going well, to what can be improved. And we have several parent advocates on our state task force to help make sure that their opinions are reflected in the plan.

As we launch the plan for South Carolina, we want parents to be engaged and involved. We would love to hear from parents that want to join our state work group or help with implementing the plan over the five-year cycle. It's going to take a lot of volunteers and be a real team effort to make the plan a reality.

Melanie Cole, MS: Dr. Hoppman, you've given us so much great information and things to think about. As a final thought, please tell us about your team and the people that you work with at Prisma Health, because really, as we were saying before, and it takes the community and caregivers, but it also takes this multidisciplinary, very caring, comprehensive team.

Dr. Anna Hoppman: I'm part of a wonderful team of doctors, advanced practice providers, nursing, pharmacists, social work, and our psychosocial care team. And we couldn't do it without any one of these members. They support our patients from the time they check into the clinic, take their vital signs, come back to the clinic room. They give them things to eat, things to do, support their mental health needs. And without them, it would be very difficult to provide the medical care we provide to treat cancer. With the aspects of the team, we're able to support the whole patient and family to get them through treatment and beyond.

Melanie Cole, MS: What a great way to end and such important points that you made. Thank you again for joining us and sharing your incredible expertise for listeners on this topic. And to hear more podcasts from our experts, please visit our website at prismahealth.org/podcast. I'm Melanie Cole. And we'd like to invite our audience to download, subscribe, rate, and review Flourish: A Prisma Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. Thank you so much for joining us on Flourish: A Prisma Health Podcast.