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

2. Conflict of Interest
I have no conflict of interests

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

5. 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.

6. 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.

7. 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.

8. More years = More Cancer
SEER Database

9. Cancer in Kids is Rare
SEER Database

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

11. 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

12. Cancer in Children

13. Cancer in Children Children are Children (NOT little adults)

14. Good News/Bad News
Cure rates have dramatically increased

15. 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)

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

17. 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”

18. 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

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

20. 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

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

23. Surgery

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

25. 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

26. 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

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

28. Absent, Not Forgotten
Bear in a Chair

29. 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

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

31. 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.

32. 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

33. 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.

35. Questions?