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Pediatric cancer treatments continue to evolve at an incredible rate, resulting in better patient outcomes.
Many recent advances owe their credit to the evolution of personalized medicine.
Personalized medicine is the practice of using an individual’s unique genetic profile to guide decisions in the prevention, diagnosis, and treatment of disease.
For many, these new treatments could mean living longer, healthier lives.
James Fahner, MDMedical Director of Philanthropy Education and Provider Wellness at Helen DeVos Children’s Hospital of Corewell Healthanswered several common questions and shared his vision for the future of precision medicine.
How has precision medicine evolved?
The practice of pediatric oncology has changed significantly in recent years, Dr. Fahner said.
“Precision medicine touches the lives of our patients and families every day,” he said.
He said his team is finding new specific targets and therapies that, in some cases, help avoid traditional treatments and their side effects.
“There are tumors that previously required very intensive surgery, radiotherapy or chemotherapy to help control the growth of a tumor. And now we see select cases where precision medicine has completely changed the regimen of care,” he said.
“When we’re lucky enough to find the right target and have the right ammunition, it can help us do things we’ve never been able to do before,” he said.
What can you do now that you were unable to do?
Dr. Fahner said the most important things are the things his team no longer needs to do.
“When we can save family time in the hospital or unnecessary treatments, we are always very grateful,” he said. “The physical cost of curing children has always been too high and as paediatricians we are always aware of the fragility and vulnerability of children at these critical stages of growth and development.”
He said exposing children to major surgeries and radiation treatments, including brutal combinations of chemotherapy drugs, would never have been a first choice.
“It was the therapy that was effective, but still cost too much,” he said.
He noted short-term side effects such as hair loss, nausea, and low blood counts, but also long-term side effects, including reduced heart, lung, liver, or kidney function, or just as concern, an impact on learning or cognitive function.
“For us, the miracle of precision medicine is what we won’t have to do in the future.”
How have the results improved?
Dr. Fahner said childhood cancer outcomes continue to improve across the board.
“I remember when many childhood cancers only had a 50/50 chance of survival or cure,” he said. “We now have many examples of childhood cancers with cure rates of 70, 80 and 90%. It’s miraculous.
Dr. Fahner said he believes the treatment of childhood cancer is one of the miracle stories of modern medicine. But with the caveat that it does indeed come at a cost.
“We are grateful for the high recovery rates, but for most it can also mean a very long and perilous journey of two or three years with multiple hospitalizations, scans, bone marrow studies, radiotherapy, chemotherapy and more. .
“If we could completely change the narrative of childhood cancer from a bazooka to a laser-centric approach…that would be our goal.”
What is one thing you thought you would never see happen in your career in medicine?
“One of the most rewarding things about our careers as oncologists is watching our children come full circle into healthy, accomplished young adults,” Dr. Fahner said. “You see it along the way when you’re invited to open houses or even wedding receptions.”
He said it is also extremely gratifying to see a number of patients so deeply touched by their care that they are committed to a career in the field of childhood cancer.
“I’ve seen many former patients become nurse practitioners, doctors or child life specialists,” he said. “Anyone who has successfully undergone treatment and wants to dedicate their career to helping kids like them.”
How have patients noticed the improvements and advancements in care?
Dr. Fahner said one of the most interesting things he has noticed is that parents are reporting fewer side effects after treatment.
“A lot of times a parent comes to the clinic and says their child has a little stomach ache after the treatment,” he said. “And in my mind, I think if it was just a few years ago, most of these side effects would have been much more serious.
“You realize how grateful you are to have more manageable or routine experiences like stomach aches instead of the extremes these kids used to go through.”
He said another really heartwarming change in patient care is that families and clinicians can confidently plan early on while fully expecting a recovery.
“It’s a very different mindset than decades ago when the prognosis was reserved,” he said.
Now, he said, the whole tone and delivery of care has changed.
“For example, we’ll say ‘keep up with your schoolwork because you’re going to go to college and one day become a successful adult…who’ll be completely cured of this cancer,'” he said.
Dr. Fahner now expects his patients to grow up, marry, start families and lead normal adult lives after treatment – results that weren’t as certain as in years past.
How does all of this positively impact patients?
“We want to make sure our children and our families get through this journey as intact as possible,” Dr. Fahner said.
There are many things we cannot avoid or change, he said.
“But as much as possible, we aim to protect the child’s childhood as much as possible so that they go through this truly upsetting and life-changing experience ready and able to face the next chapters of their life. “
Dr. Fahner said recently that he reflects on three decades of developing the childhood cancer program at Helen DeVos Children’s Hospital.
“And a big part of the success of our program is based on the importance we place on true teamwork. We have our small morning group every day and discuss treatment plans for families with particularly difficult diagnoses,” he said.
“Everyone always comes together with a goal as a team. This is truly the miracle of multidisciplinary care, and we are grateful to have all of these incredible and dedicated team members available to our children every day.
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