Childhood cancer: Dramatic Advances, and the Challenges Ahead

Childhood cancer: Dramatic Advances, and the Challenges Ahead Kenneth S. Polonsky, MD

More than 50 years ago, less than 10 percent of children diagnosed with cancer survived. Thanks to advances in diagnostics, treatments and drugs, that number has increased to 80 percent. This is a remarkable achievement, as any family with a child who has survived cancer knows.

Still, we have much work to do, and the ongoing retrenchment in research funding threatens to slow gains that will help children and young adults with cancer. Cancer remains the No. 1 cause of disease-related death in children. Those who survive suffer from long-term health effects of their cancer treatment, such as heart problems, endocrine disorders and secondary cancers later in life.

Unlike many adult cancers, the causes of pediatric cancers remain largely unknown because they are relatively rare -- about 10,400 U.S. children under age 15 were diagnosed with the disease in 2007, according to the National Cancer Institute. Pediatric cancers also form quickly, behave differently than adult cancers, and aren’t necessarily tied to environmental risk factors, posing unique challenges for researchers and health care professionals.

Despite these hurdles, progress has been made on a number of fronts.

The University of Chicago Medicine has an integrated survivorship program for patients diagnosed with and treated for cancer before age 21.

The Childhood Cancer Survivors Center focuses on identifying those at risk for long-term and complex health issues due to their past treatment, allowing for early interventions to prevent clinical disease. Its director, Tara Henderson, MD, has helped to establish national screening guidelines to detect malignancy at the earliest possible stage in women exposed to radiation in their youth and who, as a result, are at an increased risk of breast cancer.

Similarly, Kenan Onel, MD, PhD, and his Familial Cancer Clinic’s research program study the genetic basis of the disease and use this information to help families assess their risk for cancer and implement strategies to minimize this risk. He and his colleagues found two genetic variations that predict which patients with Hodgkin lymphoma are likely to develop second cancers years after initial treatment. Children at risk could be identified by genetic testing and their treatment modified to prevent this serious long-term complication.

Meanwhile, Susan Cohn, MD, has developed a database containing information on patients from four continents with neuroblastoma, a tumor of nerve tissue, the most common solid cancer found in young children. Using data from so many patients will enable investigators to identify characteristics of the tumor, allowing for individualized treatments that can improve outcomes.

Many pediatric chemotherapy treatments use adult drugs in lower doses, putting the children at risk for long-term complications. James LaBelle, MD, PhD, and Matthew Tirrell, PhD, of our Institute for Molecular Engineering, are working on a new class of drugs adapted for children that use cellular suicide mechanisms to attack resistant leukemia cells. We anticipate that such advances will not only improve outcomes, but also make novel bone marrow transplant and cellular therapy approaches accessible to more children with cancer.

Such work illustrates the power of medical discovery in pediatric medicine. The University of Chicago Medicine, along with colleagues nationwide, will continue to advocate for funding research that promotes and protects our children’s health.

Kenneth S. Polonsky, MD
Executive Vice President for Medical Affairs, University of Chicago
Dean, Biological Sciences Division and Pritzker School of Medicine