Eric J. Lowe, MD Division Director, Pediatric Hematology/Oncology Cancer, Kids and School Eric J. Lowe, MD Division Director, Pediatric Hematology/Oncology

Conflict of Interest I have no conflict of interests

Objectives Overview of Childhood Cancer Reasons to “Visit the Nurse” Side Effects – Short and Long Term How to get help

The Lifetime Probability of Developing Cancer for Men, 2007-2009* The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer. Presently, the risk of an American man developing cancer over his lifetime is a little less than one in two.

The Lifetime Probability of Developing Cancer for Women, 2007-2009* The risk of an American woman developing cancer over her lifetime is a little more than one in three.

Estimated Cancer Deaths in the US in 2013 Lung cancer is by far the most common cancer in men (28%), followed by prostate (10%), and colon & rectum (9%). In women, lung (26%), breast (14%), and colon & rectum (9%) are the leading sites of cancer death.

More years = More Cancer SEER Database

Cancer in Kids is Rare SEER Database

That Said Cancer is the leading cause of death due to medical reasons in the pediatric population (Accidents and homicide)

What is Childhood Cancer? Childhood Cancer is the leading cause of medical death in children under 18 The median age at diagnosis is six years old Some forms of pediatric cancer have a 5 year survival rate of more than 90%, while others have a 5 year survival rate of less than 2%. NOT ADULT CANCER

Cancer in Children

Cancer in Children Children are Children (NOT little adults)

Good News/Bad News Cure rates have dramatically increased

Good News/Bad News Cure rates have dramatically increased 80% expected to be cured Lots of physical, emotional, social, educational side effects (both short and long term)

Childhood Cancer Facts Will I See a Child with Cancer? Childhood Cancer Facts

What Causes Childhood Cancer? Simply put: we do not know Genetics plays a larger role than adult cancers BUT there is no single genetic mutation thus no “silver bullet”

Treatment for Childhood Cancer Multi-disciplinary Nurses Educational support Oncologists Surgeons Radiation Oncologists Support Services: Pathologists, ICU, Blood Bank, Pulmonary, Renal, etc. Pharmacists Psychosocial support Research

Treatment is not benign Devastating for family Affects Jobs Sibs Other family School Income Etc.

Treatment is not benign Child with Acute Myeloid Leukemia Chemotherapy consisted of 5 courses total From diagnosis to completion: 171 days 155 days spent in the hospital 17 days spent in the ICU (2 separate visits) 35 transfusions IV nutrition for 85 days

Not Benign Teenager in high school with osteosarcoma Length of treatment was 50 weeks 19 4-5 day admissions for chemotherapy 12 admissions for complications (3-12 days) IV nutrition needed Surgery to replace entire femur with prosthesis and then rehab

Surgery

Nurse Visits During Treatment Risk for infection - Fevers are emergencies Fatigue Bowel/bladder changes Hormonal changes Memory changes Depression Medications

Fever Fever during treatment is a BIG deal Considered Oncological Emergency Why? Immunosuppression leads to increased risk Central venous lines lead to increased risk Sepsis is bad

Bowel/Hormones/Fatigue/etc. Many, many reasons to visit nurse More background the better e.g. “my fingers are tingling and I have a headache” Brain tumor – could be an issue Leukemia – likely side effect of vincristine When in doubt call – we are always happy to help and discuss any child

Psychological Children with cancer feel different from their peers. Children have major trust issues. No peers and no adults to trust = problems

Absent, Not Forgotten Bear in a Chair

Medications Best advice I can give is to have/do 3 things Get Medication List Ask parents what medications do what and when to use Have number to oncology clinic on this list

Cost of Cure Long term effects Psycho-social Second Cancer Insurance Heart Lung Reproductive Endocrine Neuro – learning, attention Psycho-social Second Cancer Insurance

After Treatment As many as 2/3rds of survivors have at least one chronic health effect. 25% of survivors have severe or life-threatening effects. 10% will develop a secondary cancer.

After Treatment Toxic therapies damage more than just the cancer cells. Developing children are at higher risk: Delayed/ Disrupted cognitive development Stunted Growth Damaged speech and/or hearing Infertility and Endocrine Dysfunction Learning Disabilities Physical Handicaps

Unintended Effects Siblings are often put to the side. They are worried, resentful, and feel abandoned. These children may develop behavioral problems, anxiety, or depression. They may also begin to have trouble in school.

Questions?