Transcription:
Treatment and Care for Children with Cancer

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. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. Joining me today is Dr. Alexander Chou. He's an assistant attending pediatrician, New York Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Pediatrics at Weill Cornell Medical College Cornell University. And he's here to tell us about his approaches to treating and caring for children with cancer.

Dr. Chou, thank you for joining us again today. I'd like to jump right in with the first question, is there any way to prevent cancer in children? Can you tell us about any possibilities of preventing cancers in children, or might genetic testing be a route to, at the very least, alerting a family to the possibility or risk of pediatric cancer?

Dr Alexander Chou: Hi. It's really great to join you today to talk a little bit about these things. I think, in general, there's very few ways that we can prevent cancers in kids. The one thing that I really want parents and patients to really understand is that there's nothing that you did or didn't do that causes a child to have cancer. But for the most part, we don't know why kids' cancers happen. In adult cancers, there have been links to things like tobacco smoking and alcohol consumption and other environmental exposures. But in children, that's not the case. And so, I would never want any parent try to think that they could have done something or should have done this or not done that whenever they're diagnosed with cancer. And so, there's not really a lot that we can do to prevent cancers in general in kids.

Now, you brought up the idea of genetic testing. I think that we've made strides in terms of understanding some of the genetic components to why cancers happen. And the most recent studies point to the fact that maybe up to about 10% of kids' cancers might have an underlying hereditary risk associated with it, meaning that some of these cancers, and it's a fairly small number, 10% or so, where there is a gene that may be inherited that may have predisposed these kids to developing cancer.

Now, I don't advocate for genetic testing as a whole for a healthy child. But I think that if a child is diagnosed with cancer, what we can do is see if there might be one of those genes that's present that may have contributed to the cancer. And then from there, they can help us not only take care of the child, but also take care of the family and to think through some of the ramifications of what that means. I think that we work very closely with our genetic counselors and our geneticists in order to provide that information for families.

Melanie Cole (Host): Thank you for letting us know about that, Dr. Chou. How do you address the fears of patients and their parents once they've been diagnosed? Because I think that that is really the crux of helping patients and parents get through a cancer diagnosis. I'd like you to speak about how you address their fears and also your philosophy of care for these children. How are you qualified uniquely to care for these children and their parents during a time that's considered to be one of their biggest fears come true?

Dr Alexander Chou: The message that I always try to lead with in any kid who's been diagnosed with cancer and to tell their families, I think, is that there is hope. There's hope for cure. There's hope for beating this disease once and for all. I think one of the great advances in medicine over not just the last 50 years, but the last 10 years, is how we've been able to take cancers that were previously considered incurable and make them curable. And if you look at the latest statistics for pediatric cancers, 80 to 90% of all childhood cancers are curable. Now, that doesn't make it easy to do, and certainly we understand that children and their families go through a lot in the pursuit for cure. But I think that the hope is there, that we work towards curing every patient that we see of their cancer.

And now, in terms of my philosophy care, I've been doing this for a long time now, and I've taken care of kids with cancer in several different institutions with a variety of different resources. And the thing that I like to stress and the way I think about taking care of children and their families is that each patient is different and we want to take care of each patient individually.

And my philosophy of care really centers around several different concepts or ideas. The first of which is being compassionate. The care that we deliver, the care I hope to deliver to all of these kids is a compassionate one where we take into account patient's preferences, we take into account if there is specific situations, both medically as well as emotionally and spiritually and psychologically.

Another tenet is the idea of, you being holistic in the way we take care of these kids. I work with a big team of people, nurse practitioners, physician assistants, nurses, child life specialists, social workers, work with others in other subspecialties. We all come together to take care of the child. And our job is to not just cure them of their cancer, but also take care of the rest of them because we know that, even though cancer may affect a specific part of their body, we know that it touches on so many other parts, not just their biopsies, but also their lives.

And the other big tenet that I hold onto is to be data-driven, to be informed by the most recent results, the most up-to-date techniques. And I think that's Weill Cornell Medicine. And all the subspecialties that we have, especially in pediatrics, allows for that kind of individualized, compassionate, holistic, and data-driven care that I think all patients should get.

Melanie Cole (Host): Well, that's certainly an area that Weill Cornell excels at, is that patient-driven care. And I'd like you to expand for just a minute, Dr. Chou, on how you help the families, emotionally, psychosocially with those complications and even physically. Because you did mention just briefly, you know, for kids, they're growing, they're going through puberty, they're going to school, they're doing all of these things. There's a social life they want to have, but also maybe they're in chemo, maybe they're in any kind of treatment that affects their appearance or the way that they feel. What are some of the things that Weill Cornell Medicine does to go above and beyond to help those families with that portion of a diagnosis like this?

Dr Alexander Chou: That's a very important part of how we get patients to be better. What I'm really proud of is the team that we've assembled here in pediatric hematology oncology for the care of these kids. None of us can do this alone, and we certainly rely upon different subspecialists here at Weill Cornell Medicine. We have the entire gamut, the entire range of medical subspecialties that are necessary to care for any child, and not just with cancer, but with any other illness that might affect them.

But I think just as importantly, we have a team of social workers, child life specialists, even teachers, chaplains and other support members and even former patients who will come around a family, a child and help them go through what is arguably one of the hardest times in their lives. And we do this knowing that different patients will have different needs and we will tailor it to whatever the family needs are at the moment.

Melanie Cole (Host): Well, I think that's such an important point, is what they need at the moment. And that's really such a help, especially when you talk, Dr. Chou, about the multidisciplinary approach. Tell us a little bit about the services that help so that parents don't have to run around from place to place to place with their kids, because that really adds to that toll that it takes on families if they have to go to 10 different places in a week, but really when they can do everything at Weill Cornell Medicine.

Dr Alexander Chou: Yeah, I think that's certainly one of the advantages. and one of the reasons why I really love working here with the team at Weill Cornell, is that we have every pediatric subspecialty that is necessary for us to take care of these kids. So, we have specialists in heart diseases, cardiac diseases, as well as infectious diseases, lung diseases, liver diseases, all of these different areas where I know that the chemotherapy that I administer might affect them. And so, we can easily have patients be seen in one visit by multiple subspecialties, on the same floor even. And so, that patients don't have to worry about making appointments here and there. We also have people such as our social workers and child life specialists and physical therapists. They're all here at the main campus. So, they will actually come to outpatient visits. They'll come to the inpatient visits, so that much of the care that we deliver is actually right here and will come to you to make sure that we can at least take the stress off of the traveling part, but knowing that the subspecialties that we have here, the different services are world-class people who are taking care of these patients and their families.

Melanie Cole (Host): And that's such a wonderful approach for these families that are just going through so much. As we wrap up, Dr. Chou, I'd like you to reiterate how a diagnosis does not necessarily mean the worst for children. I'd like you to speak about some of the exciting things happening in the world of pediatric oncology and on the horizon, what you see, think, or hope will happen, and about how there is really a lot of hope in a child's cancer diagnosis and what you see going on in the future.

Dr Alexander Chou: Yeah, I think that's probably the one thing that I try to have patients and parents understand when they first come see me. No one really wants to see an oncologist ever. But in kids, what ends up happening is what we know is there is such hope for these patients and their families. So for example, we know more and more about the biology behind some of the cancers that these kids get. And because of that, we can individualize patient's therapy plans based on specifically a child's given tumor. And so, that not only means the kinds of medicines that we can use, whether it's chemotherapy or immunotherapy, and we have lots of different new agents being developed in those realms. But also, things like surgery and radiation therapy. So, those are other things that some children with cancer will need to have in order for patients to be cured. And we have evolving techniques, evolving ways of adapting some of those techniques specifically to kids in surgery where they're using minimally invasive types of techniques to improve recovery time and minimize the pain that kids go through.

Then, we have newer radiation techniques that minimize the kind of potential damage that can occur to surrounding normal tissues when we are trying to target specific tumor tissues. And that we have ways of personalizing the kinds of medications, whether it is traditional chemotherapy or some of the newer agents that we have, like immunotherapy agents for these kids with cancer. So, we utilize the entire gamut of treatment modalities, as we call them, to help every child with cancer.

Melanie Cole (Host): Certainly a lot of advancements and it's moving quickly. And really, we know that we're going to see some really positive things on the horizon. And thank you so much, Dr. Chou, for joining us today and sharing your expertise. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. For more health tips, go to weillcornell.org and search podcasts. And don't forget to check out our Back to Health. I'm Melanie Cole. Thanks so much for joining us today.

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