How to cope when your child has cancer

Transcript

Amanda Wilde (Host): In sickness and in health, parents are children’s source of love, support and security. Today, we look at how to cope when your child has cancer with Dr. Aniket Saha, pediatric hematologist-oncologist with Prisma Health.

This is Flourish, a podcast brought to you by Prisma Health. I’m Amanda Wilde. Dr. Saha, thank you so much for being here. As an oncologist, you see all kinds of cancers every day. What are the most common types of cancer in children?

Dr Aniket Saha: So most commonly, children have blood cancers or also known as leukemia. They are the most common cancers of childhood. As kids get older, in their teenage years, they tend to have more cancers that are called lymphomas, like Hodgkin’s lymphomas, which you may have heard of. Other types of common cancers include types of solid tumors, like brain cancers. And of course, you can also have kidney cancers, which are commonly known as Wilms’ tumors, liver cancers, bone tumors, soft tissue sarcomas, and things like that. And then, there are also some really, really rare cancers also that occur. But generally speaking, leukemias and brain tumors are the most common types of cancers that you see in children.

Amanda Wilde (Host): With the cancers children experience, are there early warning signs or symptoms we can look for?

Dr Aniket Saha: That’s a good question. And parents are always going to wonder about whether they have missed some signs or symptoms of their child being sick. And it depends on the type of cancer. So if a child has a leukemia, then they may have unusual bruising that just sort of does not make sense and seems out of proportion to whatever activity the child is engaged in, bruising that just is not explained as typically a telltale sign. Sometimes you might have a three or four-year-old who was previously walking and now is limping, which does not make sense to the parent because of bone pain that they may have from the leukemia inside their bone marrow. Sometimes, they could be unexplained fevers for long periods of time that, again there are no obvious reasons that the parent can attribute those fevers to. So those are typically what leukemias present with.

Things like solid tumors, like when we talk about brain cancers and things like that, of course, they can present with very bad headaches, vomiting, sometimes seizures. Sometimes they can have cranial nerve abnormalities, meaning that one side of the face just looks a little bit different than the other, like their eyes might be deviating to one side and things like that or weakness on one side, those kinds of things make us worry about brain tumors.

And then, we talk about bone tumors, you know, pain in the knee or pain in some joint or a part of a bone and things like that, again that’s something that you cannot explain, that should prompt some kind of a visit to their primary care physician. And a lot of abdominal tumors that occur in the kidney, the parent may notice that there’s abdominal swelling, abdominal pain, again that does not make sense, other than just your normal aches and pains.

So those are the kinds of things that generally will lead a parent to seek medical attention from their primary care physician who then examines the child, may do some blood work and then we get a phone call.

Amanda Wilde (Host): I was just going to ask what happens once we see those signs, take our child to the doctor, and you’ve just answered that, you do some testing. And then, in your experience, when a child is diagnosed with cancer, what is the most important thing parents can then do?

Dr Aniket Saha: At that point, the important things are to make sure that they are listening to their primary care physician and their hematologist-oncologist, trying to be there for their child. I mean, those are some things that should be very obvious for the parent. But sometimes, that gets lost because of all the craziness that’s happening.

Sometimes staying calm as much as you can, you know, given everything that’s going on can help the child recognize that, “Something serious is going on, but my parents have it under control to maybe some degree.” This is obviously devastating and there are implications of the cancer diagnosis and the treatment. And this can be very hard for parents, but I think those are the kinds of things you really want to ask as many questions as you think is necessary to your physician and listen to the medical team, heed their advice, talk to family members, get support from the community, things of that nature.

Amanda Wilde (Host): Well, let’s talk specifically about going into treatment. How are the cancers you see in children treated?

Dr Aniket Saha: So cancer therapy has evolved over the last 70, 80 years. Generally, the treatment is going to depend on the type of cancer as you may guess. There are three ways to kill cancer. One is to poison it, which is what I do, that’s to give chemotherapy. The other is to cut it, which is done by a surgeon if you have a tumor or something like that that needs to be taken out. And the third is to burn it, which is what a radiation oncologist does. And for certain types of cancer, we give radiation as well. And then, depending on the type of cancer, we would choose a combination of these approaches.

And then, just in the past 20 years or so, we have seen tremendous strides made in terms of the chemotherapy portion of cancer treatment. Chemotherapy generally will kill the cancer cells, but can also affect various parts of your body because it kills indiscriminately, so to speak. That’s more of a shotgun approach, whereas now we have more targeted agents, medicines that can only will sort of target the cancer cell itself and different genetic mechanisms that may be involved with the development of that cancer, so now we know how we can use our own body’s own immune system to treat cancer. So there are a lot of advances being made to develop more of these targeted precise therapies that are more and more to the forefront.

Amanda Wilde (Host): Will targeted treatment eliminate side effects of cancer treatment?

Dr Aniket Saha: In some ways they can, but again, everything has a potential price. These targeted agents have a different side effect profile that you would not see with your conventional chemotherapy treatment. So everything has its pluses and minuses, it’s just a matter of figuring out which one is the best thing for that patient.

Amanda Wilde (Host): Right. It’s a weighing of risks. Will pediatric cancer treatment affect a child’s growth or development after the treatment ends?

Dr Aniket Saha: It most definitely can. A lot of it is dependent on the treatment that is given. So for example, if you think about a child with a brain cancer, and if they get radiation to their brain, that can affect the pituitary gland, which secretes a lot of hormones that the child needs to grow and that can affect their growth, so that’s one thing. Different kinds of chemotherapy agents can cause a lot of side effects with regards to growth as well. And those are fairly common. And there are some chemotherapy agents that can affect your heart, some affect your lungs. So there is a price that unfortunately the child can pay for the cure rates that are so high. But we are working towards mitigating a lot of those risks and monitoring children very carefully after their treatment is done. We see them very, very regularly to make sure that we can catch things early and intervene if needed.

Amanda Wilde (Host): So you do follow these kids after treatment. And what do you do when growth or organs are affected by chemotherapy?

Dr Aniket Saha: Yeah, it just sort of depends on whatever the side effects are. Let’s say, if they have issues with their thyroid gland, which can happen, then we would give them thyroid replacement. If they have issues with their cognitive function, we would provide their school with the testing results that we would do to figure out that they have some cognitive issues. And then, we would ask the school to intervene and provide the child with additional help and time for their school work. So all those kinds of things that you can do. So it totally depends on the type of the long-term side effect and what exactly the side effect is and what the intervention could be.

Amanda Wilde (Host): Are there particular things you’ve seen that parents can do to help their child during and after treatment?

Dr Aniket Saha: Just be involved. Talk to your physician about your concerns. And that’s probably the most helpful thing that a parent can do and also to be an advocate for their child as well. So it sounds vague, but if you really think about it and use that advice, you can actually get a lot of things for your children as they’re going through cancer treatment.

Amanda Wilde (Host): Yeah. Well, you’re talking about different forms of support, which leads me to this question. Parents also have to think about other family members. So, you know, what can parents do to help siblings of a child with cancer?

Dr Aniket Saha: I will say that in my experience and in the experience of many other pediatric oncologists, we see a lot of siblings being left behind, because the focus becomes on that sick child. Rightfully so, you want to pay attention to that child that is sick, but there are a lot of siblings that do feel like they’re sort of the child that no one really pays attention to anymore. So, our program here at Prisma Health upstate, we have sibling support groups. We have our child life specialists who know this and they alert the parent to make sure that they spend time with their child’s siblings as well to make sure that they don’t feel left out because, as you can imagine, this is quite common.

Amanda Wilde (Host): Can you talk a little more about what support services are available to the patient and their family?

Dr Aniket Saha: So that will depend from place to place. So at Prisma Health, we work with a lot of our philanthropic partners within the community who help patients cope through various things. So, we have organizations that help patients with the financial toxicity that they may be going through. within our clinic itself, we have embedded psychologists and neuropsychologists that help patients in that regard and also their families. We have social workers, we have child life specialists. So those are the things that we have close within our clinic, as well as in our community as well.

Amanda Wilde (Host): That’s such a relief to hear there is support available because you just can’t do this alone. It’s a team effort.

Dr Aniket Saha: Absolutely.

Amanda Wilde (Host): Doctor, thank you so much for your insights that really empower parents who are dealing with a child’s cancer diagnosis.

Dr Aniket Saha: Thank you so much for having me.

Amanda Wilde (Host): For more information and other health podcasts, go to PrismaHealth.org/Flourish. This has been Flourish, a podcast brought to you by Prisma Health. I’m Amanda Wilde. Be well.