Bringing Together the Best Minds in Pediatric Cancer Care

CHOC Children’s is taking the concepts of second-opinion consultation and tumor board planning at least six steps further. The Virtual Pediatric Network (VPN) uses state-of-the-art video conferencing to allow pediatric cancer experts from six leading institutions to share best practices, research and expertise as if they were all in the same room.

“No one institution can be an expert in every cancer, but with the VPN, these hospitals can work together to bring the best care to patients wherever they may live,” said Dr. Leonard Sender, medical director, Hyundai Cancer Institute at CHOC.

Described as a “multidisciplinary second opinion,” the tumor board concept has become an important cancer-fighting resource at hospitals in recent years. Tumor board meetings typically involve staff from across medical, nursing, psychological and rehabilitative disciplines who evaluate, diagnose and plan treatment for individual patients.

In a similar fashion, the VPN is comprised of five medical centers and one research institute for genomic medicine: CHOC, Lucile Packard Children’s Hospital at Stanford, Kapi’olani Medical Center for Women & Children, Duke Children’s Hospital & Health Center, Rady Children’s Hospital-San Diego and the Translational Genomics Research Institute. With CHOC serving as the hub, all are connected through the CISCO TelePresence video conferencing system, a secure network made available by a grant from CISCO to the CHOC Children’s Foundation.

According to Dr. Sender, the TelePresence system offers the highest level of video conferencing technology available. Optimized for exceptional sound and picture quality, the system captures every expression, gesture and voice inflection, creating a collaborative environment that leads to deeper discussion, enhanced information sharing and improved decision making.

“The VPN is an opportunity to leverage technology to allow for greater collaboration and, hopefully, innovation between children’s hospitals and cancer programs,” Dr. Sender said. “This will lead to potentially better science and provide pediatric patients the greatest opportunities for survival and quality of life.”

The VPN has the potential to standardize and improve care for pediatric patients throughout the world, Dr. Sender added. CHOC and CISCO are already planning to expand the network to additional locations and specialties, including pediatric institutions in Australia and the United Kingdom.

Learn more about the Hyundai Cancer Institute at CHOC Children’s.

More posts about innovation at CHOC Children’s:


Treating the Teen Cancer Patient

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.”

“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.

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.


  • 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


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, an adolescent cancer advocacy organization.

“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.”

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

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.

“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. In this five-part ...

A Bright Future: Amy’s and Emily’s story

I’m more than half way through my 50-week CHOC gratitude tour, and I just met two others who want to join me in thanking the hospital for our bright futures: Meet Amy and Emily.

Sisters Amy and Emily believe they IMAGE_2have two birthdays: the days they were born, and the days they were diagnosed with cancer before beginning treatment at CHOC.

Each day is met with equal celebration. Amy and Emily, ages 29 and 18, see the anniversary or their diagnosis – their cancerversary – as the day they began the long road toward health.

“We think that’s the day of them starting to get better,” says their mother, Denise Justiniano. “We made that day a good memory. We eat dinner together as a family and make a fun time out of it.”

Both women received treatment as children at the Hyundai Cancer Institute at CHOC. Amy spent six months in the hospital after being diagnosed with lymphoma in 2001. Diagnosed with leukemia in 2008, Emily still receives treatment at CHOC’s outpatient infusion clinic.

And today both women are moving forward: Emily graduated from high school last June and is now in her second semester at college. About seven months ago, Amy gave birth to her second daughter.

“The nurses and doctors at CHOC are amazing,” Amy says. “Not only do they offer the best medical care, but they are empathetic and caring, and offer emotional support in a way that you would expect only a friend to. If it weren’t for CHOC, I wouldn’t be here today. They made a huge difference in my life and helped me become the person that I am today.”

Watching two children battle cancer was heart-wrenching, but Denise credits CHOC staff and fellow families and patients with helping to ease the experience.

“When we first arrived at CHOC with Amy, everyone came out of their room as we were coming down the hall,” she says. “They’re were talking to us, patting us on the back. It was like a warm hug.”

And their time at CHOC made an impression on more than Amy’s and Emily’s health: Amy is a nurse at a local hospital, and Emily is pursuing a career as a nurse practitioner.

“For us, it was the nurses who made CHOC home for us and made it manageable and joked with us,” Denise says.

And CHOC’s impression has extended further into the Justiniano family: Inspired by the CHOC child life staff who helped her sisters cope with hospitalization, a third daughter, Sarah, volunteers at CHOC and is pursuing a career in the child life department.


Oncology: Then and Now

Much has changed in oncology the last 50 years. In the 1960s, childhood cancer survival rates were less than 20 percent. Today, survival rates near 80 percent, according to the National Cancer       Insti20130423_0071tute.

Isn’t that astounding? It’s been amazing to watch the changes in cancer diagnosis, treatment and knowledge since the time I first visited CHOC in 1964.

Today, the Hyundai Cancer Institute at CHOC Children’s provides personalized pediatric cancer treatment by nationally recognized specialists. Physicians and staff treat not just the child’s cancer, but her whole needs: emotional, spiritual and physical. CHOC believes that children should still get to feel like kids, even when dealing with a grown-up issue like cancer.

Because many patients battling cancer spend a long time in the hospital, I’ve gotten to know many through the years. Like all CHOC patients, they are brave and courageous. They inspire me, and I’m thankful every day for them and the doctors who provide their care.

Send them your best wishes in the comments section or on social media by using the hashtag #thxCHOC.


The Hyundai Cancer Institute at CHOC Children’s believes in a team approach to providing treatment to patients that includes a multidisciplinary team of physicians and specialists and the patient’s family. A cancer diagnosis touches the lives of the entire family, and that’s why the Cancer Institute is dedicated to a family-centered approach to care that includes immediately pairing patients and their families with a pediatric oncology nurse coordinator who serves as an advocate for the child and family throughout the patient’s course of treatment.