A bold new world in pediatric cancer care | Corwell Health

Treatments for childhood cancer continue to change at an amazing pace, leading to better patient outcomes.

Many of the recent advances are due to the development of personalized medicine.

Personalized medicine is the practice that uses an individual’s unique genetic profile to guide decisions in the prevention, diagnosis, and treatment of disease.

For many, these new therapies may mean living longer, healthier lives.

James Fahner, MDmedical director of charity education and caregiver at Helen DeVos Children’s Hospital at Corewell HealthHe answered many of our frequently asked questions and shared his insights on the future of precision medicine.

How did precision medicine develop?

Dr. Fahner said that the practice of pediatric oncology has changed dramatically in the past several years.

“Precision medicine touches the lives of our patients and families on a daily basis,” he said.

He said his team is looking for specific new targets and treatments that, in some cases, help avoid traditional treatments and their side effects.

“There are tumors that used to require very extensive surgery, radiotherapy or chemotherapy to help control tumor growth. Now we’re seeing select cases where precision medicine has completely changed the system of care.”

“When we’re lucky enough to find the right target and get the right ammunition, it can help us do things we haven’t been able to do before,” he said.

What can you do now that you haven’t been able to do?

Dr. Wahner said the most important things are the ones his team no longer needs to do.

“When we can save family time in the hospital or unnecessary treatments, we always feel grateful,” he said. “The financial cost of treatment for children has always been very high, and as pediatricians we are always aware of the vulnerability of children at these critical stages of growth and development.”

He said exposing children to major surgeries and radiation treatments, including harsh combinations of chemotherapy drugs, would never have been a first choice.

“The treatment was effective, but it was always very expensive,” he said.

He noted short-term side effects such as hair loss, nausea, and low blood counts, but also long-term side effects including decreased heart, lung, liver, or kidney function, or an effect on learning or cognitive function.

“For us, the miracle of precision medicine is what we won’t have to do in the future.”

How did the results improve?

Dr. Fahner said pediatric cancer outcomes continue to improve across the board.

“I remember the days when many childhood cancers had a 50:50 chance of survival or cure,” he said. “We now have many examples of pediatric cancers with cure rates of 70, 80 and 90 percent. It’s a miracle.”

Dr. Fahner said he believes the cure for childhood cancer is one of the miracle stories of modern medicine. But with the caveat, that does come with a cost.

“We are grateful for the high cure rates, but for most people, this can also mean a very long and treacherous two- or three-year journey with multiple hospitalizations, scans, bone marrow studies, radiation therapy, chemotherapy and more.

“If we can completely change the pediatric cancer narrative from a bazooka to a laser-focused approach…that would be our goal.”

What is one thing you thought you would never see happen during your medical career?

“One of the most gratifying things in our professional lives as oncologists is to see our children come full circle into healthy young adults,” said Dr. Fahner. “You see it all the way when you get invited to graduation open houses or even weddings.”

He said it was also gratifying to see a number of patients so deeply affected by their care that they dedicate themselves to a career in childhood cancer.

“I’ve seen many former patients transition to become nurse practitioners, physicians, or child life specialists,” he said. “All those who have had a successful journey in therapy and want to dedicate their careers to helping kids like them.”

How have patients noticed improvements and advances in care?

Dr. Fahner said one of the most interesting things he noticed was that parents reported fewer and less serious side effects after treatment.

“Often a parent will come to the clinic and say their child has a little upset stomach after treatment,” he said. “And in my opinion, I think, if this had only been a few years ago, most of these side effects would have been more severe.

“You realize how grateful you are to have more manageable or routine experiences like an upset stomach rather than the extremes that these kids used to go through.”

Another really comforting change in patient care, he said, is that families and doctors can confidently make plans from the very beginning of anticipation of treatment.

“That’s a very different mentality than there was decades ago when the prognosis was cautious,” he said.

Now, he said, the whole tone and delivery of care has changed.

“For example, we’ll say ‘Keep doing your homework because you’re going to go to college and become a successful adult one day… who is completely cured of this cancer,'” he said.

Dr. Fahner now expects his patients to grow up, get married, have a family, and lead normal adult lives after treatment — results not nearly as certain as in years past.

How does all this positively affect patients?

“We want to make sure our children and families come through this journey as safe as possible,” said Dr. Fahner.
He said there is a lot we cannot avoid or change.

“But as much as we can, we aim to protect a child’s childhood as much as we can until they go through this truly overwhelming, life-altering experience and are ready and able to face the next chapters of their lives.”

Dr. Fahner said recently that he’s been reflecting on three decades of building the children’s cancer program at Helen DeVos Children’s Hospital.

“And so much of the success of our program is due to our focus on a real team effort. We meet every morning and discuss treatment plans for families with particularly difficult diagnoses.”

“Everyone always comes together with a purpose as a team. It truly is the miracle of multidisciplinary care, and we are grateful to have all these amazing, dedicated team members available for our children every day.”