Pediatric Care
Addressing Childhood Cancer
Lisa Diller, MD
What signs might lead your child's pediatrician to suspect cancer?
It's difficult to list cancer symptoms because cancer is so diverse, and diagnosis is further complicated because many signs and symptoms — like fever, bruising and headaches — are normal in healthy children.
My experience has shown me that pediatricians are extremely skilled at distinguishing the usual bumps and pains from the concerning ones. They sense which symptoms truly need evaluation and astutely order tests using the character, duration and severity of symptoms — and oftentimes instinct — to help them.
What advice do you have for parents whose child has been diagnosed with cancer?
For most pediatric cancers, parents should remain positive. Cure rates have been steadily improving; the most common diagnosis, acute lymphyblastic leukemia (ALL), now has a more than 80 percent cure rate. As with ALL and most other pediatric cancers, the intent is to cure, not to buy time. Many families' prior experience with cancer is with elderly relatives, and it's important to keep in mind the good prognosis in children.
Is it important to seek care from a pediatric facility?
Absolutely. Nearly all children in the United States with cancer are treated at a pediatric tertiary care institution or subspecialty center. The need for pediatric pathologists, radiologists and surgeons in the diagnosis and treatment of pediatric cancers cannot be understated. Brain tumor care is a great example: pediatric neurosurgeons, neurologists, neuropathologists and neurooncologists are skilled at diagnosing tumors, like medulloblastoma and optic glioma, which are rarely seen by our adult medicine colleagues.
What should a family expect if their child has cancer?
Let's use ALL as an example. Oncologists often receive a late afternoon call about a child seen in the office earlier that day whose complete blood count results suggest ALL. We usually see these children in the emergency room the same day.
Depending on the child's state, they will either be seen in an outpatient facility or admitted to a hospital for care. The patient will undergo preliminary tests, which may include MRI scans, blood work or X-rays. This process may take several days, but the goal is to arrive at an accurate diagnosis. A multi-disciplinary team of pediatric specialists, including an oncologist, surgeon, radiation oncologist, pathologist and radiologist, will evaluate the test results, make a final diagnosis and design a treatment plan. If a child is hospitalized during the diagnostic period or for treatment, a parent can usually sleep at the bedside.
At home, well-meaning relatives and friends often overwhelm parents. Families should be direct about what they do and do not need. When friends offer help, suggest they donate blood. Though donations may not directly benefit their child they care so much about, more blood will be available for other sick children. Many parents comment on how helpful neighbors and friends have been: caring for other children at home, making meals and driving visitors, including friends, to visit the patient.
With a child who has been diagnosed with cancer, what role does their primary care practitioner (PCP) assume?
PCPs are the first to find abnormalities and recommend parents consult a specialist. We see most of our patients after their pediatrician discovered something of concern, often during a well-child check. If a diagnosis of a malignancy is made, the pediatric oncology team provides most of the clinical care, but PCPs assist with outpatient care by monitoring blood counts and nutrition levels or providing nursing support.
After treatment, children enter a two-year transition period during which the focus is on risk of recurrence and side effects of therapy. Pediatricians are an integral part of the child's return to normal life, and a dialogue between oncologist and pediatrician is essential, especially around well-child care, growth and immunizations. Eventually, the focus changes from risk of recurrence to risk of late effects from treatment — screening becomes crucial for late effects of anticancer drugs and complications, including endocrine abnormalities, learning issues, secondary cancers or cardiac dysfunction.
Where should parents obtain information?
Rely on information available on the websites of reliable cancer institutions like the National Cancer Institute (NCI) and the American Society of Clinical Oncology. In fact, the NCI Web site offers brief overviews of the most updated therapeutic approaches. Parents and children can also visit the nearest medical facility offering cancer therapies to access books, videos and meet with resource specialists.
Source: Lisa Diller, MD, is Clinical Director of Pediatric Oncology at Dana-Farber Cancer Institute and Children's Hospital Boston. A pediatric oncologist with a special interest in neuroblastoma, she also studies the late effects of pediatric cancer.
