Treatments for many pediatric cancers have improved to the point that a child’s cancer diagnosis come with an 84 percent cure rate. Of course, that means cancer is still fatal for almost 16 percent of young patients and that rate is much higher in some forms of the disease. Likewise, hopeful survival rates fail to capture the very real, long-term effects that come with treatments for many childhood cancers. What does life look like 30 years after whole-brain radiation or an aggressive surgery? There are reasons why cancer remains a life-altering diagnosis for young patients and their families. But there are also reasons for hope. Here are five reasons the future looks brighter for pediatric cancer patients:
1. New Treatments
Just a decade ago, many cancer doctors saw immunotherapy as a dead end. Now it’s a fourth pillar alongside chemotherapy, radiation and surgery. And many researchers think immunotherapy is still in its infancy compared to what it could become. But immunotherapy is just one avenue for new, innovative treatments against childhood cancers. Since the 1990s, gene therapy has been oncology’s flying car – it always seems like it’s just around the corner. Now the CRISPR gene-editing technology has reenergized the field and the payoff for gene therapy seems closer than ever. Right behind gene therapy are at least a dozen innovative strategies like leveraging the microbiome and attacking cancer cells with heat. A decade from now, one or more of these new treatments may prove to be the next immunotherapy.
2. New Technology
Not only are we speeding the delivery of new treatments, but technologies are speeding the pace at which we can develop these new therapies. It took 13 years – from 1990 to 2003 – for scientists to decode the first human genome. Now it takes a few days for oncologists to pinpoint the faulty genes in a patient’s tumor that are driving their cancer. In the lab, new technology lets researchers test thousands of drugs against samples of human cancers, and can compare complete genomes of healthy and cancerous cells to notice the genetic differences that could become the targets for new drugs. This technology-driven explosion in our ability to understand cancer at a basic, biological level is the base of the pyramid on which new treatments are built.
3. New, More Specific Targeting
Systemic therapies used to be the norm – for example, to treat cancer in the brain, doctors had to irradiate the entire brain, and chemotherapies introduced to the whole body did almost as much harm as good, attacking healthy tissues along with the cancer. Now we’re learning to use these same therapies in much more targeted ways. Instead of whole-brain radiation, doctors are using radiosurgery (also called stereotactic radiation) to precisely target tumors without nearly the amount of damage to surrounding brain tissue. And new strategies like “prodrugs” attach a molecule of chemotherapy to a molecule that specifically seeks out cancer cells, delivering high-dose chemotherapy only where it’s needed.
4. New, Personalized Medicine
It’s not only drugs that are becoming more targeted – the patients who get these drugs are becoming more targeted, too. Based on a patient’s genes and especially on the genetic makeup of their cancer, some treatments will work better than others. This is true to the degree that a drug that’s useless for some patients might be a cure for others. The more we learn about which drugs work with which patients, the more doctors are able to match patients with the treatments that offer the most benefit with the lowest risk.
5. New Appreciation for the Emotional Side of Illness
Since the first chemotherapies started to show hope for pediatric cancers more than 50 years ago, doctors have been laser-focused on healing patients’ bodies. It makes sense: Survival has to be the first step. But now that patients are living longer and longer, it’s becoming clear there is another side of the disease: Cancer is traumatic and trauma can lead to lasting mental and emotional health challenges. Finally, the field of cancer care is catching up with this reality and new resources and tools are being leveraged to deal with the psychological effects of medical trauma. Therapy and counseling are becoming part of the standard-of-care, and there are even tools like the game Shadow’s Edge to help individuals explore their trauma at their own pace, in their own space.
Cancer is hard. It’s hard on a young patient’s body, their brain, and on their emotions. But maybe the most encouraging news for young cancer patients and their families is not only that treatments are getting better, but the pace at which treatments are getting better is accelerating exponentially. It’s not the tortoise and not even the hare, but more like an airplane taking off. Ten years from now, today’s treatments for childhood cancer will seem like looking down at the ground from 30,000 feet. And with continued funding and research, the outcomes in both body and mind will ensure that many cancers end up being manageable detours in a healthy child’s path into the world.
Garth Sundem is a parent, husband, and author of books including “Real Real Kids, Real Stories, Real Change”.