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:

  • How Parents Can Help Teens Manage Their Health Care
    When it comes to health care matters, parents of teenagers must strike a delicate balance, especially when the teen is old or mature enough to make his own decisions. Parents can ...
  • 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 ...
  • Helping Adolescents and Young Adults Cope with Cancer
    There’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 ...

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:

  • How Parents Can Help Teens Manage Their Health Care
    When it comes to health care matters, parents of teenagers must strike a delicate balance, especially when the teen is old or mature enough to make his own decisions. Parents can ...
  • 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 ...
  • Preserving Fertility in Adolescent Cancer Patients
    When treating children and teens 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, ...

Gift Puts Genomic Research into High Gear

annual-report-2013-genomic-researchFor more than a decade, the cure rate for pediatric cancer has been stalled at about 80 percent. A multidisciplinary team of specialists at the Hyundai Cancer Institute at CHOC Children’s is working to find cures for the other 20 percent—and won’t stop until they do.

Thanks to a gift in 2011 of $10 million from Hyundai Motor America, the largest corporate gift in CHOC’s history, Leonard Sender, M.D., medical director of the Cancer Institute, and his team are conducting cutting-edge genomic research to better understand cancers that occur in children and teenagers.

Whole genome (DNA) sequencing of both tumors and healthy tissue and transcriptome (RNA) sequencing of tumors is being conducted to identify the molecular profile of cancers occurring in patients, according to Dr. Sender. The goal is to identify genetic mutations that may be responsible for a child’s cancer, and to determine how cancer cells differ from cells that have mutated but are noncancerous.

Once whole genome and transcriptome sequencing procedures are performed, the data is analyzed by oncologists, cancer epidemiologists, cancer biologists and bioinformaticists. Their aim is to identify treatments and available medications that may be beneficial for the patient based on the molecular profile of the cancer.

“Even if we are unable to identify a treatment that is available now, the information learned may be used to help us better understand what causes cancer and how it may be treated or prevented in the future,” Dr. Sender said.

Related articles:

Sun Smarts: Kids, Sunscreen and Melanoma

This article was featured in the Orange County Register on August 19, 2013 and was written by Shaleek Wilson.

View the full feature

CHOC_08-20-2013_sunscreen_half

SUNLIGHT EXPOSURE

Orange County is one of the sunniest places in California, with hundreds of sun days per year. With that comes the need for protection. Improper protection can increase risk for skin cancer. “People get skin cancers, the most serious being melanoma, because we get too much exposure to the sunlight,” says Dr. Sender. To ward off harmful UVA and UVB rays, use sunscreen. “Most people don’t put enough on,” explains Dr. Sender. “We recommend about an ounce for each area of exposed skin, i.e. leg or arm.”

THE RIGHT NUMBER

SPF stands for Sun Protection Factor. It should be applied liberally and more often than most people think, he explains. “Sunscreen should be put on 30 minutes before you go out in the sun,” says Dr. Sender. So, what’s the magic number? 15? 50? 100? “Never go in the sun with less than SPF 30,” he says. “Use the broad-spectrum variety and reapply every two hours.”

MORE ABOUT MELANOMA

Melanoma accounts for 4% of all skin cancers. Malignant (life-threatening) melanoma starts in cells that produce pigment (color) in skin. It usually begins as a mole that turns cancerous. People with all skin types may be affected, but those who are fair-skinned and burn easily are at a higher risk, says Dr. Sender.

THE ABCD’S OF MOLES

Although melanoma is still rare in kids, parents should make checking for moles part of their monthly routine. Look for Asymmetry, Border, Color and Diameter. “Get to know your child’s skin; if all the moles look the same and one is different, that’s the one you need to worry about,” Dr. Sender says. “It should never be bigger than a pencil eraser.”

With early detection, melanoma is curable, so be safe and use common sense in the sun:

  • Apply sunscreen, even on infants 6 months and older
  • Wear wide-brimmed hats
  • Protect your eyes; wear sunglasses

FAST FACTS

  • Cases of skin cancer in the U.S. every year: 1.3 Million
  • Percentage of sun rays blocked when SPF 30 is applied: 90%
  • Time of day when the sun is the strongest: 10am – 4pm

 

CHOC Pediatric Cancer Specialist
Dr. Leonard Sender
CHOC Pediatric
Cancer Specialist

PHYSICIAN FOCUS: DR. LEONARD SENDER

Dr. Sender is the Medical Director of Hyundai Cancer Institute at CHOC’s Children’s as well as CHOC Children’s Specialists Division chief of Oncology; and Medical Director of Clinical Oncology Services at UC Irvine Medical Center’s Chao Family Comprehensive Cancer Center. He completed his fellowship in Pediatric Hematology/Oncology including Hematopoietic Progenitor Cell Transplantation.

EDUCATION:
University of Witwatersrand School of Medicine, South Africa

BOARD CERTIFICATIONS:
Pediatric Hematology/Oncology

More about Dr. Sender

 

Now Cancer Has Nowhere To Hide

ar-2012-now-cancer-has-nowhere-to-hide

The latest super weapon in the fight against cancer, genomic medicine, literally leaves cancer no place to hide. this cutting-edge technology analyzes and develops individual tumor profiles for patients whose cancer has returned.  Oncologists may use this additional genomic data to identify existing treatments or develop new ones.

Last year, Hyundai, and its nonprofit organization, Hope On Wheels,® contributed $10 million toward pediatric cancer research, naming the Hyundai cancer institute at CHOC children’s.  That unprecedented corporate gift let our experts take the search for cancer cures down to the molecular level.

“It took 13 years and $3 billion to sequence the first human genome, but the technology has become much faster and cost-effective in recent years,” said Dr. Sender.  “We have begun sequencing patients whose cancer has returned, giving oncologists remarkable insights into individual tumor profiles.”

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