Transcription:
International Childhood Cancer Day

Melanie Cole (Host):  There’s no handbook for your child’s health. But we do have a podcast, featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. And our topic today, is International Childhood Cancer Day and joining me is Dr. Jennifer Levine. She’s an Associate Professor of Clinical Pediatrics in the Division of Pediatric Oncology at Weill Cornell Medicine and an Associate Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Levine, it’s a pleasure to have you join us today. Let’s start with the prevalence. How common is cancer in children? Tell us a little bit about the incidence that you see.

Jennifer Levine, MD, MSW (Guest):  Cancer overall is still extremely rare in children. In the United States, we expect to see about 15,000 to 16,000 diagnoses a year. But again, overall given the population across the United States, that’s really a very small number.

Host:  So, then what are the most common cancers in children and adolescents? Which cancer types tend to affect children the most?

Dr. Levine:  Overall, leukemia is the most common diagnosis and among the leukemias, is the subtype called acute lymphoblastic leukemia and it’s by far the most common diagnosis. And it is also one that over time we’ve become extremely good at diagnosing. In the adolescent population, we continue to see numbers of leukemia but there are also higher numbers of cancers like Hodgkin’s lymphoma and some of the sarcomas which are bone tumors.

Host:  Since this is terrifying for parents to get this diagnosis and I think the million dollar question Dr. Levine is can childhood cancer be prevented at all? Is there anything that you want parents to know about things their families can do?

Dr. Levine:  The answer to that question really at this time, is that in the general population, there really is nothing that can be prevented or practices that families can follow to prevent cancer. And part of that is really because in children, there aren’t things like there are in adults like smoking that are practices that we really know lead directly to cancer. It is possible in the future, that we may know more, and that answer might change. But at this point in time, there really are no things when a child with cancer comes to us where we can look back and say that this was causative. There may be very small numbers of children in whom there is already a known cancer predisposition syndrome in other members of the family. And in those families, there probably are already discussions around how you would follow those children. But that’s really not true for the general population.

Host:  Well so then along those lines, and we know there are risk factors as you say for adults with diabetes or heart disease. Are there risk factors? How would a parent know if their child is at risk? Is it strictly random? Is there a big genetic component to these? How would we know?

Dr. Levine:  There really is not a big inherited genetic component to childhood cancers. So, that is not really something that parents would be looking out for. And I think it’s very hard for any parent to actually identify that their child is at risk for cancer. I think there may be signs and symptoms as a child presents or what a parent might be noticing that might raise concerns for a family that cancer could be occurring, but really not something that points to risk.

Host:  Well then let’s talk about the children that have been diagnosed. And it’s such a scary time for the whole family. What are some of the things that children with cancer face, social life for teens with cancer. How do you help kids as they go through this chemotherapy? How tough are kids and what are they going through?

Dr. Levine:  Children and adolescents perhaps children more than adolescents, are incredibly resilient and I think in some ways, way more so than their adult counterparts facing this. But there is no doubt that a cancer diagnosis is an enormous life changing event or any child or adolescents and their family. And it has a dramatic change in what their daily life looks like and their outlook is I would say overall. In many young children, they may not be so aware of kind of what the changes are in their life and it’s more that they really become just kind of accustomed to the processes that are associated with going through cancer and there are many things that are really very difficult when you think about blood draws, and getting chemotherapy and being in the hospital.

As children get older; as you mentioned, socially, it really does change a lot and there are often periods of time where children really are not able to go to school. This becomes increasingly relevant to them the older that they get, and those school years really are important in terms of what comes next with high school or college. And I think for individual patients, there are so many different experiences about how those around them respond in terms of their friends and other family members. And whether their friends are still a part of their life where things change, and I’ve certainly heard a number of adolescent patients in particular say that they learn who their real friends are going through this process.

I do think that we also do hear that while nobody is going to choose to go through this kind of an experience; that sometimes the children, the adolescents and their families really learn somethings going through this process where they themselves identify themselves as even more resilient moving forward and thinking about the things in life that are really important to them.

Host:  That’s so interesting. You just gave me chills. And as we’re talking about the things that families go through; what about fertility in males and females? As kids are going through puberty, and they’re adolescents and they get cancer, can that affect their future fertility? And what do you want them to know about when a fertility specialist should be brought in? What complications can happen?

Dr. Levine:  First of all, I think it’s certainly very important for every patient, every family who is facing this diagnosis to at least have a conversation about fertility to try to understand for themselves what those risks are including if there risk is low. But certain kinds of chemotherapy, there’s a class called alkylating agents and radiation therapy particularly to the gonadal tissues, so the testicles or the ovaries can absolutely affect somebody’s fertility in the long term. We tend to think about males and females differently and we also think about children who haven’t gone into puberty yet, a little differently than those who have gone into puberty.

So, for males, who have gone through puberty, we actually make a recommendation that they all strongly consider sperm banking regardless of what we think their ultimate risk is going to be. Because there can be unforeseen circumstances. First of all, we’re not always 100% perfect at knowing who will be, in fact we are far from 100% perfect in terms of knowing who will or won’t be fertile later, although we are able to risk stratify. But males after completion of chemotherapy regardless of what they’ve gotten often are not able to make sperm and if they have a relapse, they may have lost an opportunity to sperm bank. So, that’s actually a recommendation that at least here at Weill Cornell, we make regularly.

For prepubertal males, even when there are risks; there is currently no intervention that reliably helps to preserve their fertility. There are experimental methods know as testicular tissue biopsies and cryopreservation that may allow, if we learn more about how to use that tissue later on to restore fertility.

Males across the age group though, their risk tends to be the same whether they are younger or older. For females it’s different because women in general, their fertility changes over the course of time and the older they get, the potentially less fertile they are later on in life.

So, prepubertal girls may again be at risk if they are exposed to very high doses of alkylating agents and radiation but they are starting off with very high numbers of follicles in their ovaries. Very recently actually, the procedure that has been used in this population which is the procedure is called ovarian tissue cryopreservation has been deemed nonexperimental by the ASRM which is the American Society For Reproductive Medicine. And that is where we actually take a piece of tissue out of from the ovary, it gets frozen and the idea is that it can actually be reimplanted later on.

For post-pubertal girls, again at high risk, their options are they can actually freeze eggs similar to what some individuals may do who are concerned that they might go into menopause before they’re ready to have children. So, it’s really the same procedure. They also have the option of ovarian tissue cryopreservation. Again, these are for higher risk patients. I think the most important thing to consider is that there is a discussion about what the priorities are for the patient and family. I would say that among the two most common questions that come up with a new diagnosis relates to what we were talking about before which is could I have done anything differently and the second are questions about fertility.

Host:  Well thank you for that comprehensive answer. It’s really interesting. So, let’s talk International Childhood Cancer Day briefly here. It is a global collaborative campaign to raise awareness about childhood cancer and to express support for children and adolescents with cancer, survivors and their families. What do initiatives such as this do to help raise awareness? Tell us what you know about awareness and families and what we can do to help.

Dr. Levine:  So, I think that awareness really has an impact on a number of different levels. The first in terms of awareness I think actually is potentially more for individuals who know people who have a diagnosis of cancer. So, trying to think a little bit about how as a community we can be supportive of individuals who are going through this to not be afraid to step in and say these are the things that I’d like to do to be able to help. We hear a lot that it is much more helpful for somebody to come in and say here's what I can do to help than what can I do to help. Because everybody is always so overwhelmed that even thinking about what you can do to help is additive.

I think that the awareness also allows us to understand how exceptional the treatment is in first world developed countries like the United States. And how different it can actually be across the world. And so, the opportunities that we have quite frankly, for virtually any child who is diagnosed in the United States; they really do have access to exceptional care in virtually every medical center because it is so rare that almost every child goes to a specialized center like Weill Cornell to receive their treatment. And again, this is not the same internationally. And in fact, at Weill Cornell, not infrequently, we will take care of individuals who live outside of the country, who come to us to seek medical care.

Host:  As we wrap up, Dr. Levine, and it’s such great information and so important for not only cancer survivors and their families but for their neighbors and their community to hear from you about all of these different things that they are going through and treatment options. What would you like the families to know and the community at large to know about children and cancer and awareness and how we can all get involved and help each other?

Dr. Levine:  The strides that have been made in the treatments of pediatric cancer are exceptional. And when you take all children diagnosed across the board; our expectation is that the survival rate these days really exceeds 80% and, in some diagnoses, including leukemia, there are instances where those cure rates are greater than 95%. And that is really a combination of our ability to do research to move forward both the treatment options but also the supportive care options. So, how do we keep children healthy while they’re going through this treatment? How do we help support how they are feeling while they are going through this so that when they become adults, they’re ready to be out there and be full citizens of our society. That they have jobs, that they are married, that they themselves have children. And I think that overall optimistic outlook is something that’s really important. It also requires that we do pay attention to the instances where we have not come as far and I think that broadly, what we really require is the ability to continue to do the research in those areas so that all diagnoses that a child can have really result in the amazing outcomes that we’re seeing in our most common diagnoses.

Host:  What a hopeful message. Dr. Levine, thank you so much. Dr. Jennifer Levine and to our listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs; please follow us on your social channels. I’m Melanie Cole.