CHOC Children’s Joins National Cancer Consortium

The Hyundai Cancer Institute at CHOC Children’s took yet another bold step in its fight against pediatric cancer by uniting with Cancer Moonshot 2020.  CHOC is one of 10 founding members of a national pediatrics consortium announced at a press conference on Feb. 18, 2016, and dedicated to accelerating cancer cures through immunotherapy.  All partners will seek to apply the most comprehensive cancer molecular diagnostic testing available, and leverage proven and promising combination immunotherapies and clinical trials. Real time data sharing is designed to accelerate clinical learning for all consortium members.

“The Pediatric Cancer Moonshot 2020 will attempt to cure all the numerous types of pediatric cancer with the least toxicity by harnessing patients’ own immune systems and using the tumors’ unique genomic mutations to create individualized cancer vaccines,” explains Dr. Leonard Sender, medical director, Hyundai Cancer Institute.

Dr. Sender has positioned CHOC a leader in the field of innovative genomic medicine techniques. In addition to being designated a Caris Center of Excellence for its commitment to precision medicine, CHOC is a participant in the California Kids Cancer Comparison, bringing the benefit of big data bioinformatics to its patients. And, CHOC recently enrolled its first patient in a multi-center clinical study for the treatment of relapsed or refractory acute lymphoblastic leukemia (ALL) with investigational immunotherapy.

“CHOC has studied whole genome sequencing for several years, and our team recognizes its value to clinical decision making. Now, with the availability of the next generation of molecular diagnostics, we are excited by the acceleration of knowledge that this system will provide and are honored to be a founding member of such an important initiative,” says Dr. Sender.

20140916_2770 Three major drivers of the Cancer Moonshot 2020 Pediatrics Consortium are:

  1. The recognition that cancer is caused by any one of a multiple number of genetic mutations, with thousands of molecular alterations presenting within each pediatric cancer patient. Consortium members and their patients will benefit from the most comprehensive molecular diagnosis in the market today.
  2. The significant fragmentation across the healthcare ecosystem. More specifically, pharmaceutical drug development often occurs in silos with limited ability to share clinical information. Consortium members recognize that collaboration across medical and scientific communities will help remove barriers to accelerated progress in the war on pediatric cancer.
  3. The lack of a comprehensive data sharing system, including participation by pharmaceutical companies, for individual children cancer centers. Consortium members will have access to Cancer Moonshot 2020’s national, robust and scaled cloud infrastructure enabling the ability to share data in real time and provide access to breakthrough knowledge.

In addition to CHOC, founding members of the Cancer Moonshot 2020 Pediatrics Consortium are:

  • Ann & Robert H. Lurie Children’s Hospital
  • Children’s Healthcare of Atlanta
  • Children’s Hospital of Philadelphia
  • Children’s Hospital of Pittsburgh of UPMC
  • Duke Department of Pediatrics at Duke University School of Medicine
  • Floating Hospital for Children at Tufts Medical Center
  • Huntsman Cancer Institute at the University of Utah and Intermountain Primary Children’s Hospital
  • Phoenix Children’s Hospital
  • Sanford Health

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 ...

Kids and Cancer

Girl with tongue out

THE DIFFERENCES BETWEEN ADULT AND CHILD CANCER CARE
“The pediatric cancer patient is never an individual, but is looked at in the context of the family,” says Dr. Sender, explaining the need for a family-centered treatment approach with young cancer patients. “Kids have siblings. They have parents. We try to understand that patient as a child, or teen, or young adult, but we also understand how they fit into  their family and the family dynamics. In adult medicine, the family’s wishes are often secondary to the patient’s wishes. In pediatrics, they can be equal or overshadowed. A three-year-old can’t define what they want to do but with teens, we try to find the balance between the patient’s and the parent’s wishes.”

DEVELOPMENTAL CONSIDERATIONS
Pediatric cancer patients are classified in one of three major groups: young children, tweens/early teens and teens/young adults, says Dr. Sender. Developmental issues and stages of the child’s growth, including in utero before birth, are  considered. “We think of adult cancers as the consequences of living your life. In childhood, it really is more about developmentally what is going on. Sometimes the cause is unknown,” says Dr. Sender.

CARE WITH COMFORT
Children with cancer are not just considered “little adults” in terms of care. “We want them to still be children,” says Dr. Sender. “We make sure that we provide an environment that is nurturing and comforting to the family. This is very stressful for these families. We are always thinking of that. We have a team-centered approach. We have oncologists, social workers, psychologists, child life experts and others all working to provide the young patient with as normal of a life as possible while they are being treated. CHOC is truly committed. It’s our passion. We want to deliver the most advanced treatment we can.”

DO TEENS AND YOUNG ADULTS HAVE UNIQUE ISSUES RELATED TO THEIR CANCER TREATMENT?
Adolescents and young adults into their late 30s who are being treated for cancer face a wide range of issues that need to be considered to help them cope. These issues include fertility preservation, the development of body image, career and education considerations, and dealing with an increased dependence on parents at a time when many in this age group strive to be more independent.

FAST FACTS

  • The incidence of childhood cancers (up to age 15) that are diagnosed as leukemia: 1/3
  • The number of pediatric cancer cases (up to age 15) diagnosed annually in the U.S.: 14,000

View the full feature on Kids and Cancer

Dr. Leonard Sender
Dr. Leonard S. Sender
CHOC Cancer Specialist

PHYSICIAN FOCUS: DR. LEONARD S. SENDER

Dr. Sender is the medical director at 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.  He also is a professor of medicine at UC Irvine. 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 in  Los Angeles. Dr. Sender has twice been named a “Top Doctor” by U.S. News & World Report. He 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 people, 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

More about Dr. Sender | More about The Hyundai Cancer Institute at CHOC Children’s

This article was featured in the Orange County Register on January 28, 2014 and was written by Amy Bentley.

Helping Adolescents and Young Adults Cope with Cancer

girlwithcancerThere’s never a good time for a cancer diagnosis, but the teen and young adult years can be an especially tough time for cancer patients. Adolescents and young adults into their 30s who are being treated for cancer face a wide range of issues special to their age group that need to be considered to help them cope. These issues include fertility preservation, the development of body image, career and education considerations, and dealing with an increased dependence on parents at a time when many in this age group strive to be more independent.

“Teens are starting to enter adulthood and move away from parents. They are starting to become more of an individual. In the normal struggle between the teenager and their parents, you throw cancer into the mix and you create tremendous stress. This is a time when they want to be independent but they are sick,” explains Dr. Leonard Sender, director of the Hyundai Cancer Institute at CHOC Children’s and specializes in the unique issues relating to cancer treatment in adolescents and young adults from the ages of 15 to 39.

For several years, Dr. Sender has served as an advocate for this very special group of patients through the SeventyK that he co-founded in 2008 and currently chairs. Dr. Sender is especially sensitive to the psychosocial impacts of a cancer diagnosis on those just beginning to enter their most productive years. He remains a vocal advocate for this group, working to make sure they receive age-appropriate medical treatment and support, including, psychosocial, community and palliative services. In 2010, Dr. Sender founded two entities critical to the development of the emerging adolescent and young adult oncology subspecialty as president of the Society for Adolescent and Young Adult Oncology (SAYAO) and editor-in-chief of the Journal of Adolescent and Young Adult Oncology (JAYAO).

According to SeventyK, adolescents and young adults with cancer have often been described as a medically underserved population, falling through the gap between pediatric and adult oncology. As they transition from childhood to adulthood, the normal issues people in this age group face are compounded when they are diagnosed with cancer.

These patients may face treatment-related issues such as infertility; the loss of a job or breaks in education due to treatment; increased dependence on parents; and other health concerns, all of which can be exceptionally difficult for this group to cope with. Fertility preservation, in particular, has long been overlooked for adolescents, especially considering the fact that many young men and women haven’t yet started to think about having children. Adolescent and young adult patients may need extra support or psychological help to cope.

“Our goal is to cure these kids,” says Dr. Sender. “We bring in the best science, the best clinical delivery of care that we can. We always take into account the developmental stage of these patients. We never lose sight of the fact that these patients undergo tremendous amounts of interventions that can physically and emotionally scar them. We try to think about them as survivors from day one.”

Related articles:

  • 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 ...