OUR INSTITUTES: CANCER | HEART | NEUROSCIENCE | ORTHOPAEDICS
 
 

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Making a Mark
Making a Mark is published bi-annually by the CHOC Foundation. It features CHOC and children?s healthcare news, patient highlights, hospital updates, board member spotlights, and community involvement stories and is mailed to donors who support CHOC with a gift of $250 and more.

Cancer Institute Overview

In 1948, Dr. Sidney Farber achieved the first clinical remission with chemotherapy ever reported for childhood leukemia, ushering in the era of modern oncology.

About 10,000 children under the age of 15 will be diagnosed with cancer this year, according to the American Cancer Society.

Dr. Leonard Sender, medical director of the CHOC Cancer Institute, explains, “in the 1940s, children with leukemia were given about six weeks to live. Today, 90 percent are cured. That’s great news that we celebrate, but other cancers have not enjoyed the same improvement in the survival rate.”

“We have to ask the question,” Sender continues, ‘what haven’t we done about other types of cancer?’ At the CHOC Cancer Institute, that’s a large part of our undertaking: to increase cure and meaningful survivorship for children, adolescents and young adults with cancer.”

Despite significant progress in the prevention, treatment, and prognosis of many childhood cancers, it is still the chief cause of death by disease in children under age 15 and the fourth leading cause of death in children ages 1 to 19.

The CHOC Cancer Institute—the largest regional cancer treatment center dedicated exclusively to children—treats more than 80 percent of the children diagnosed with cancer in Orange County.

CHOC’s program is approved by the American College of Surgeons Commission on Cancer, one of only 17 children’s hospitals in the country to receive this distinction. It is also the region’s only pediatric outpatient oncology clinic, a National Marrow Donor Program site, and a member of the Children’s Oncology Group (COG).

“Our clinical team is nationally renowned for providing exceptional care within a multidisciplinary and familyfocused setting that is highly individualized. We look at every patient as an individual, tailoring a custom treatment plan that’s right for them,” Sender says.

Clinical Trials
 

The dramatic improvement in overall childhood cancer survival in recent years has been made possible through collaborative research and participation in clinical trials offering the latest advances in the treatment of childhood malignancies.

As a member of COG, CHOC provides patients with access to leading-edge clinical research trials—studies that aim to determine the most effective treatment for a particular disease. In addition, COG and CHOC are invested in conducting additional studies that provide clues about the biology of childhood cancers, psychosocial studies to assess how disease impacts the wellbeing of the patient and his or her family, and long-term survival studies.

A common question is how new drugs are developed to treat cancer. All new pharmaceutical agents undergo a rigorous testing process overseen by the United States Food and Drug Administration (FDA). The drugs are tested in different phases, each of which has it own unique characteristics.

Phase I trials are conducted in a small group of patients to determine whether the drug is safe and at what dosage it is safe. In phase II trials, drugs are evaluated for their ability to treat disease in a larger group of patients. Phase III trials are conducted in yet a bigger group of patients at a large number of facilities to confirm a drug’s effectiveness and to compare the new treatment with an established standard of care. Finally, phase IV trials are conducted as post-marketing trials looking at longterm safety and use.

According to Dr. Sender, “there are exciting new drugs coming out, but they need to be tested. We are fortunate to be a Phase I clinical trial hospital, meaning we are able to use the latest, and potentially greatest, drugs that may hold the cure when conventional therapy and later phase studies have failed to achieve the desired therapeutic response.”

Dr. Violet Shen, who oversees clinical trials for the CHOC Cancer Institute, adds, “clinical trials are an important step in order for oncology treatment to continue to improve. They enable us to discover which cancers respond best to new treatment modalities. They also help us determine the safest way to give new drugs.”

CHOC has clinical trials open for leukemia and cancers of every organ system, either for newly diagnosed or relapsed patients. CHOC also collaborates with major pharmaceutical companies to conduct clinical trials on new chemotherapeutic agents and supportive care to alleviate the side effects of chemotherapy.

“We want to give our patients’ families hope. With clinical trials, we can provide our patients with more options,” Shen says.

Adolescent & Young Adult Program
 

Although cancer is a relatively rare disease in children and adolescents, it occurs more often in people between the ages of 15 and 30 than in children ages 14 and younger. And the incidence appears to be rising.

The Adolescent and Young Adult (AYA) Cancer Program at CHOC is designed to give cancer patients ages 13 to 21 access to the latest treatment alternatives in a multidisciplinary environment that stresses improved outcomes and enhanced quality of life.

This dedicated program offers the full spectrum of services, from sophisticated clinical protocols to psychosocial services such as college and work counseling geared toward adolescents.

One of the few pediatric-trained oncologists in the nation who also works with adults, Dr. Sender serves on the AYA committee for COG. The AYA committee is committed to addressing cancer, its diagnosis, treatment, and long-term outcomes in people who are 15 to 39 years old.

“We have made fantastic advances in how we treat children ages 14 and younger with cancer,” Sender explains. “Today, 75 percent of all pediatric cancer patients may look forward to adulthood, compared with 10 to 20 percent just 30 years ago. But adolescents and young adults with cancer have typically not fared as well because they have not had the same access to such leading-edge care.”

“There is a delivery gap in care since parents often do not know whether to take their older child to a pediatric facility or an adult hospital,” Sender continues. “There is also a knowledge gap since cancer is often not considered in this patient population. Finally, there are few research protocols developed for adolescents and young adults; the majority are for younger children or for older adults.”

“For me, there is nothing worse than thinking there may be an adolescent out there who is not getting the best possible care. We know what we are doing, and we can treat these patients according to the best protocols available for their specific types of cancer,” Sender concludes.

The Recurrent/Refractory and Palliative Cancer Program
 

The Recurrent/Refractory and Palliative Cancer Program at CHOC offers a clinical team of experts for the evaluation and treatment of patients with progressive disease who are not responding to therapy and newly relapsed and second malignancy patients.

According to Dr. Ivan Kirov, director of the Recurrent/Refractory and Palliative Cancer team, “once a cancer recurrence is diagnosed, a treatment plan is developed. Whereas 50 years ago little could be done for a patient whose cancer had recurred, this is no longer true. In some cases, recurrent cancer can be successfully eliminated from the body. In cases where this is not possible, the goals of treatment may include controlling tumor growth, limiting pain, managing side effects, and helping the patient to lead a normal, active life for as long as possible—often many years.”

Palliative care—treatment that relieves symptoms such as pain and nausea—is not expected to cure the disease but makes the disease more bearable. It focuses on making a patient’s life the best it can be, even if there is not a good chance of curing the cancer.

According to Dr. Sender, “in terms of palliative care, the question is, ‘how can we help a child and his or her family when a cure is not an option?’ We want to provide them with a better quality of life, using state-of-the-art, outside-the-box therapy.”

CHOC ACTS Program (After the Cancer Treatment Survivorship Program)
 

Because of significant advances in treatment, 77 percent of children treated for cancer survive five years or more, an increase of almost 45 percent since the early 1960s. With childhood cancer survivors living longer, long-term health issues have come more into focus in recent years. Researchers have learned that the effects of childhood cancer treatment may affect that child’s health later in life. This result becomes known as a “late effect.”

“As more and more children are becoming survivors, the more we realize how little we know about the potential long-term consequences of the medical treatments that got them there,” Dr. Sender says. “We want to give survivors of childhood or adolescent cancer the best chance to live as normal a life as possible.”

Just as the treatment of childhood cancer requires a very specialized approach, so does aftercare and monitoring for late effects. The ACTS Program, led by CHOC physician Dr. Lilibeth Torno, is designed to detect the development of side effects from therapy that can occur years after treatment is completed.

“The ACTS program screens, identifies, diagnoses and treats the late effects of cancer treatment as early as possible and educates patients and their families about the long-term health implications of childhood cancer survival,” Torno explains.

“There are hundreds of childhood cancer survivors in this country. Too many of them age out of a children’s hospital when they become 18 or 21 years old and are left to their own devices,” Dr. Sender adds. “We cure children, but there are consequences of their cure. We have initiated a program with UC Irvine to help transition adolescents to an adult care environment for their continuing treatment.”

“This is a unique group of survivors. We need to look at them in a special way that maximizes their chances for ongoing cure, and their ability to be functional and meaningful survivors of cancer,” Dr. Sender concludes.

The diagnosis and treatment of childhood cancers takes time, and there are both short-term and longterm side effects. But, thanks to medical advances, more and more kids with cancer are finishing successful treatment, leaving hospitals and living into adulthood.

Making Strides to Help Teens Cope with Cancer
 

A “teen wing” is being constructed this fall on the oncology floor at CHOC to provide an environment specifically designed for young adults. The Anaheim Ducks, among other generous donors, are contributing toward the creation of the new wing.

A Teen Mentor Program also has been developed to match teen oncology patients with properly screened, trained and supervised mentors who recognize the unique psychosocial concerns of adolescents and young adult cancer survivors. The mentors are cancer survivors themselves and know first-hand what it feels like to live through a cancer diagnosis.

CHOC CHILDREN'S PUBLICATIONS
PHYSICIAN CONNECTION ENEWSLETTER
KIDS HEALTH MAGAZINE
ANNUAL REPORT
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chocChildren's Hospital of Orange County | UCI University of California, Irvine

Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

CHOC Children's - 1201 W La Veta Ave, Orange, CA. Phone: 714-997-3000. .