Childhood Cancer Care: Experience Required

Sep 5, 2018

In recognition of Childhood Cancer Awareness Month, Lesley Rine, a clinical pharmacist lead at Accredo’s Oncology Therapeutic Resource Center, highlights the complexity of providing care for pediatric patients who have cancer.

Francie Article

Last year, more than 10,000 children in the United States under the age of 15 were diagnosed with cancer, a number that has been rising slightly for the past few decades.

A group of specialist pharmacists in our Oncology Therapeutic Resource Center (TRC) is focused on providing drug and disease-specific education to physicians, parents and caregivers of pediatric oncology patients.

Our work is challenging, there’s no doubt about it. It can become difficult to see cases each day of babies and children with cancer, including patients who have relapsed, and those whose only treatment option is palliative therapy. We make every effort to help quickly and do whatever we can to make life a little easier for these patients, their physicians, and their parents. At the end of each day, I’m appreciative of the many ways we’re able to help.

Because of major treatment advances in recent decades, more than 80 percent of children with cancer now survive five years or more. This is a significant increase since the mid-1970s, when the five-year survival rate was about 58 percent. Survival rates, however, vary depending on the type of cancer and other factors.

The most common cancers of children are:

  • Leukemia
  • Brain and spinal cord tumors
  • Neuroblastoma
  • Wilms tumor
  • Lymphoma (including both Hodgkin and non-Hodgkin)
  • Rhabdomyosarcoma
  • Retinoblastoma
  • Bone cancer (including osteosarcoma and Ewing sarcoma)

TRC Tackles Dosage Complexities

Physicians treating children with cancer face a lack of approved drugs specific to the pediatric population. Typically, less than 4 percent of oncology funding goes to the research and development of therapies for children. One factor in this shortage of pediatric research is due to safety. Pharmaceutical manufacturers often are looking to have the safety of a product established in adults before including children.

That leaves physicians and pharmacists to face the challenge of how to administer a therapy and at what dose for a particular patient. These decisions require a strong clinical perspective that comes from familiarity with oncology drugs and experience working with pediatric patients.

When a patient is diagnosed, in nearly all cases, their first line of therapy is administered in a hospital or clinical setting. Most of the patients we treat have been prescribed an oral oncology medication as a second line of treatment, a maintenance medication, or supportive therapy to treat side effects.

Our TRC team regularly scours data on oral oncology medications to research what is available for pediatric patients. We’ve built a resource for our pharmacists to use to support patients who cannot swallow tablets and capsules. This resource provides directions for preparing solid oral dosage forms into liquid forms.

For patients receiving an injectable drug, we work with physicians and caregivers to ensure they have the appropriate size of needle and syringe, as well as other supplies, to safely administer the drug at the least discomfort to the patient.

Looking to the Future of Pediatric Medications

Despite the lack of medications with pediatric-specific labels, we know there has been a renewed vigor in research and development activity for childhood cancer treatments. We look forward to the promise of what these therapies may bring to patients and their families. Specifically, we are closely watching the National Cancer Institute – Molecular Analysis for Therapy Choice (MATCH) trial, in which patients are assigned to receive treatments based on the genetic changes found in their tumors through genomic sequencing and other tests.

In addition, recent approvals of tumor-agnostic drugs leads the way for more treatments based on a common biomarker, rather than the location in the body where the cancer originated.

Putting Families in Touch with Financial and Community Support

Accredo’s care for oncology patients begins with our work to ensure patients have access to the therapies they need. We have an industry-leading copay assistance team focused only on oncology patients. They have deep experience connecting patients with the right financial assistance, based on a patient’s medical coverage, or lack of coverage. Our team goes far beyond providing information. Instead, our experts work closely with a healthcare provider or caregiver, walking them through the enrollment process and uncovering available resources.

Our care team also includes a social worker who directly assists patients and caregivers to help provide a holistic level of support, which may range from referring a family to a counselor to help ease stress to coordinating transportation to the doctor’s office or treatment location.

As we recognize Childhood Cancer Awareness Month, let us also recognize advancements that are being made in care and treatment. Cancer survivorship has greatly improved and many of the patients we serve will live long, full lives. But, with all cancer patients, especially children, the disease requires experienced follow-up, care and monitoring.

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