Childhood cancer is rare, but when it happens, it usually brings up an endless stream of questions for parents. How did this happen? What will life be like for my child?
In this episode of Cancer Mythbusters from Dana-Farber Cancer Institute, Dr. Allison O’Neill, clinical director of the Solid Tumor Program at Dana-Farber/Boston Children’s Cancer and Blood Disorder Center answers some of the most common questions about childhood cancer.
Let’s start off with a big question: What do we know about what causes childhood cancer?
That is a big question, and I think it’s one we wish we knew more about. In truth, there have been so many longitudinal epidemiologic studies trying to arrive at more definitive risks for pediatric cancer, and the bottom line is we still don’t know enough of what causes this variety of diseases across children in general.
I think that studies are ongoing, and I think, in some cases, we do know that there might be genetic risks, for instance — but in the adult population, where we know that smoking causes lung cancer, or significant exposure to the sun can lead to melanoma. There aren’t necessarily the same environmental risks per se that we can link to childhood cancer.
Can cancer be inherited, and what would you say to parents who might think it’s their fault that their child got diagnosed with cancer?
So, yes, it certainly can be inherited. We know of a number of genetic syndromes, or cancer predisposition syndromes, that are essentially defined by a gene that is abnormal within a family that then is inherited in each generation that may lend to risk for cancer.
Now, that risk can vary substantially within generations. It can vary based on the genetic abnormality within families. The same abnormality might not be seen in two disparate families, and the risks might be very different, so just because a family has a particular gene abnormality doesn’t necessarily mean the risk between families is the same.
We actually have a cancer predisposition clinic now at the Jimmy Fund that sees all pediatric patients diagnosed with cancer. Cancer is so rare in pediatrics that I think, over time, we’re going to identify that there are more genetic causes than we previously realized.
That being said, it’s never the fault of the family. We can’t control our genetic makeup. Unfortunately, we can’t determine how these genes get passed on — by virtue of having children, genes are passed on — so really, families should never place blame on themselves. Parents should never place blame, and I think the goal of this cancer predisposition clinic, in particular, is to create surveillance programs such that we watch children with more frequency when we know they have a particular risk, such that we can, hopefully, diagnose cancer at an earlier stage, such that it’s curable.
One common question is whether children with cancer pose a health risk to other children. Can you talk about this?
Of course. They pose absolutely no risk, but I can imagine that communities might be fearful of that. I think children with cancer probably still carry some stigma. I think it’s more a stigma of the unknown. I think a lot of other children in classrooms — you know, if a child shares a classroom with a patient that’s been recently diagnosed, or if communities and families share resources — they may not know enough to realize that cancer is not contagious.
In reality, patients who are diagnosed and families that have a child recently diagnosed need more support than ever before, so I think what we need to do is break that stigma and really bring communities together to support these families.
How is cancer treatment in kids different than cancer treatment in adults?
That’s a tough question. I think the diseases are very different, so I think we need to start there. The diseases that affect adults are very different from what we see in children, with a few exceptions — there are some diseases that overlap. The disease is really what dictates the therapy. For many diseases, we still rely upon combination chemotherapy (more than one chemo therapeutic agent in different combinations delivered in a cyclical fashion).
I think our field is gradually moving more and more towards targeted therapies that are dictated by the genetic makeup of these tumors, but we haven’t yet evolved to a point where we utilize those therapies alone. What I will say is that we’re very fortunate that children are able to tolerate therapy much better than adults, in many circumstances. They are younger. Their organs are quite healthy. They’re unbelievably resilient both, I think, physically and mentally and emotionally.
So, I think many families will come into our clinic with expectations or prior experiences that lend fear to how well their child will cope with the diagnosis or the treatment, and I think what we often reassure families is that children do a remarkably excellent job of tolerating their therapies.
Many parents wonder if their children can live a “normal life” after treatment — so can they?
That’s our absolute goal. We often set patients and families up for the expectation that they should lead as normal a life as possible during their treatment, and we have a number of resources to accommodate them in school and at home, as well as their siblings and their families, but the goal, really, is for them to lead as normal a life as possible after their treatment.
Now, of course, their treatment may come with certain toxicities that are lifelong medical problems. I think, as our cancer treatments evolve and become more targeted and less toxic, or as we’re able to deliver less intensive therapy over time, the longstanding consequences of treatment are going to become more tolerable.
We have a cancer survivorship clinic at Dana-Farber where all of our patients are followed not just in childhood but well into adulthood, such that they undergo surveillance for any possible risks after having received these drugs. Certainly, many of our children undergo life-altering surgeries as well for which they may have prostheses or require significant physical therapy or occupational therapy, but again, all of these things are put in place early such that these families — that these children — can have as normal a life as possible in the aftermath of treatment.
If a child goes through cancer treatment, can they still have kids some day?
That’s a very good question. It really depends on the treatment they’ve received. So, we have recently instituted in our pediatric program a fertility specialist, who works closely with one of our pediatric oncologists, and has really established an information gathering session very early on in treatment and a plan going forward as it pertains to fertility preservation, if necessary.
So, what we review with families is the treatment that they will receive, the risks that that treatment might impart on fertility, and then we provide a number of options as it pertains to fertility preservation: if the family would like to preserve either sperm or egg and whether the child is even eligible for any of those procedures, and really, we try to counsel the family as to the risks of infertility to help them make that decision prior to initiation of therapy. So, it really is very treatment specific, but having put this program in place in the last few years, I think it has really helped families plan for the future after treatment.
A myth that we want to explore here is whether all cancer treatments are toxic — what do you have to say on this?
Yeah, that’s an excellent question, and that’s very treatment specific. So, each of the drugs we use comes with obligatory side effects, but I can say the same thing for Tylenol. If you read the Tylenol insert, there are four thousand side effects, and that’s a very benign drug, so you can imagine the same holds true for each chemotherapeutic agent we use or each targeted agent — but our jobs at the end of the day are to balance the potential side effects with the benefit of cure and the benefit of treatment. So, we are able to really compile treatment regimens that cause the least amount of harm, that are the least toxic, if possible, but confer the greatest benefit for efficacy.
And in truth, we’re getting better and better at predicting toxicities and protecting patients from them. And as I mentioned previously, our goal is really to cut back on toxic therapies when possible such that we can provide children with normal lives in the aftermath of treatment.
Is there anything else you think a parent of a childhood cancer patient should know or keep in mind?
That’s a good question. I think you brought this up earlier — parents of pediatric cancer patients always blame themselves in some way, and if I can leave you with one tidbit to these parents: Don’t blame yourselves. You did nothing to cause this, even in the context of a genetically inherited abnormality. It’s not your fault.
And I think parents often wonder whether they can be doing more, and I can tell you that you’re doing everything you can, and you’re doing your very best, and that’s what your child needs. Those are my parting words and the truth that this is difficult to go through, but the vast majority of patients and families do an unbelievable job in supporting their child.
Learn more about treatment and support for pediatric cancer from Dana-Farber/Boston Children’s.
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