Treating the Teen Cancer Patient

crop_girlPHYSICAL CHANGES
The teen years are a time when adolescents develop their self-image, seek autonomy or independence from their parents, and deal with issues of emerging sexuality, Dr. Sender says. Keeping that in mind with young cancer patients, he explains, “We try to understand and not downplay the issues of self-esteem and body image. We make sure we are talking to the patients and not just their parents. No one likes to lose his or her hair, for instance. For a young girl who is 13, 14 or 15, we realize this can be quite catastrophic.”

EMOTIONAL AND SPIRITUAL CONCERNS
“A teen’s peers are really important too, so we try to keep them involved. Peer support helps,” says Dr. Sender.  “We have social workers and nurses that talk to the patients. We try to make sure we are listening to them. We’ve taken them out of their normal routine, their school and peer relationships, and they lose control.” Patients may also enlist support from a religious leader of their chosen faith if they would like. “We respect all religions and people’s faith and how they cope,” Dr. Sender says.

TEEN CANCER PATIENTS ARE UNIQUE
Social and peer acceptance; career and education considerations; and the desire for independence are among issues to be considered when helping the adolescent cancer patient. It’s important for everyone involved in the patient’s care to consider these factors to better understand how the teen will respond to therapy, the hospital and possibly being in a clinical trial, says Dr. Sender, who noted that fewer teens and young adults nationwide participate in pediatric clinical trials compared to younger children. To help better connect teen cancer patients with their school and peers, CHOC is participating in a research project with UC Irvine that will place a robot in an Orange County
classroom — connected to a CHOC patient by a computer — so the patient can interact with classmates and have an improved sense of normalcy. Dr. Sender says researchers hope to learn whether the robot keeps the patient better engaged with peers at school.

FAST FACTS

  • Estimated number of cancer deaths that will occur this year in children from birth – 19: 1,960
  • Estimated number of new cancer cases that will be diagnosed this year in the U.S. in children ages birth-19: 15,780
  • Percentage of overall 5-year survival rate for childhood cancers: 80%

View the full feature on Teen Cancer Patients

Dr. Boon
Dr. Leonard Sender
CHOC Oncologist

PHYSICIAN FOCUS: DR. LEONARD SENDER

Dr. Sender is the medical director of the Hyundai Cancer Institute at CHOC Children’s and director of clinical operations and program development at the Chao Family Comprehensive Cancer Center at UC Irvine Medical Center. Dr. Sender completed his internship and residency in pediatrics at UC Irvine Medical Center and had a fellowship in pediatric hematology/oncology at Children’s Hospital Los Angeles. Dr. Sender serves as board chairman of the “Stupid Cancer” Foundation and is a founding member and chairman of SeventyK.org, an adolescent cancer advocacy organization.

DR. SENDER’S PHILOSOPHY OF CARE:
“I take a patient-centric approach and treat young patients as a person while understanding the context in which they get cancer. My goals are to cure the cancer and achieve a meaningful survivorship.”

EDUCATION:
Medical school at the University of the Witwatersrand in Johannesburg, South Africa

BOARD CERTIFICATIONS:
Pediatric hematology/oncology Pediatrics

More about Dr. Sender

This article was featured in the Orange County Register on June 9, 2014, and was written by Amy Bentley.

Preserving Fertility in Adolescent Cancer Patients

When treating children and teenPreserving_Fertilitys with cancer at CHOC, physicians also have another health aspect in mind: patients’ future fertility.

Because so many adolescent cancer patients are surviving into adulthood, physicians, patients and their families have a major interest in preserving a patient’s fertility, as well as the long-term effects that treatment can have on a patient’s fertility in the future, says Dr. Leonard Sender, medical director of the Hyundai Cancer Institute at CHOC Children’s.

“If we accept at CHOC that 80 percent of children and young adults are going to be cured or survive long-term, working on survivorship starts from day one,” he says. “This means we address the types of drugs we use, the therapies we use, and their long-term consequences.”

According to the National Cancer Institute, the most frequent cause of impaired fertility in male cancer survivors is chemotherapy or radiation-induced damage to sperm. For girls and young women, cancer treatment may damage immature eggs, affect the body’s hormonal balance, or harm the reproductive organs.

“We need to ask, ‘What are we doing to preserve fertility?’” Dr. Sender says.

Options for preserving fertility depend on many factors, including the patient’s gender, age, type of cancer and type of treatment. Among the ways to preserve fertility are freezing and banking sperm for the males, and freezing and banking eggs for females.

“We also do ovarian cryopreservation,” Dr. Sender says. “CHOC is one of the few institutions offering this option. These procedures may Preserving_Fertility_2have to be done before or during cancer treatment, and patients who have just received their diagnosis might only have a small window of time to decide what to do.”

CHOC is a member of the National Physicians Cooperative (NPC) of the Oncofertility Consortium, which supports cancer patients and survivors whose medical treatments may risk infertility, and offers tips for adolescent patients to consider on the topics of preserving fertility and parenting.

With input from their parents and other loved ones, young cancer patients facing this issue can ask themselves:

  • Do I want to have children? If so, how many?
  • Would I prefer adoption to other parenthood options?
  • Does it matter to me if my children are biologically related to me?
  • Am I open to using donor sperm or donor embryos?
  • Do I have ethical or religious concerns about assisted reproductive technologies?

Questions adolescent and young adult cancer patients can ask their doctor may include:

  •  Will my treatment affect my fertility?
  • Are there alternative ways to treat my cancer without compromising my fertility?
  •  What are my fertility preservation options?
  •  How much time do I have to preserve my fertility before I need to start treatment?
  • How will I know if I am fertile following treatment? Are there tests I can take?
  • What are the risks to my children based on my cancer and the treatment I received?
  • For girls and young women: Is pregnancy safe for me after treatment?

 More articles about adolescents and young adults with cancer:

  • Finding Someone Who “Gets It”
    Bri is a 22-year-old who was diagnosed with Stage 2 Hodgkin lymphoma shortly before her 21st birthday. In this five-part series, she takes readers along on her look back at ...
  • Finding Humor in Cancer
    Bri is a 22-year-old who was diagnosed with Stage 2 Hodgkin lymphoma shortly before her 21st birthday. In this five-part series, she takes readers along on her look back at ...
  • What it’s Like to be Treated at a Children’s Hospital as a Young Adult
    Brianna Miller is a 22-year-old from Southern California who was diagnosed with Stage 2 Hodgkin’s lymphoma shortly before her 21st birthday. She is a patient at CHOC Children’s. In this ...