Uncovering and Addressing Unmet Needs in Pediatric Cancer Care

Saro H. Armenian, DO, MPH

The cure rate of various childhood cancers are climbing, shining a light on the growing number of unmet needs to be addressed, such as the expanding range of survivorship issues, according to Saro H. Armenian, DO, MPH, who added that raising awareness about these needs is critical.

Armenian is the Barron Hilton Chair of Pediatrics, as well as a chair and professor in the Department of Pediatrics, director and professor in the Division of Outcomes Research/Intervention, Department of Population Sciences, and the director for the Center for Survivorship and Outcomes at the Hematologic Malignancies Research Institute, located at City of Hope in Duarte, California. He also currently holds the position of co-leader of the Cancer Control and Population Sciences Program and director of the Childhood, Adolescent and Young Adult Survivorship Program at City of Hope.

In an interview with OncLive^®, Armenian discussed ongoing research that aims to enhance the quality of care for childhood cancer survivors and highlighted the importance of these initiatives. Armenian shared additional insights on the care of pediatric patients with cancer and the specific long-term health challenges that are present within this patient population in another article, which was published during Childhood Cancer Awareness Month in September 2024.

OncLive: How is current clinical research transforming standards of care in childhood cancers?

Armenian: At this point, when you look to the cooperative groups, such as the Children’s Oncology Group in North America, which includes over 200 institutions across the country, you would be hard pressed to find a clinical trial that does not use biologic information, genomic information, or biomarker information to stratify patients, stratify therapies, and refine and personalize those therapies. Across most clinical trials now, the standard of care is becoming personalization of therapy based on the unique molecular signatures of these cancers. That is [what the pediatric oncology field has] become.

Ultimately, in [pediatric oncology], when there are appropriate opportunities to [consult] the adult cooperative group setting, the pediatric community is now working with these adult communities in clinical trials to ask important questions that affect kids with cancer, as well as adults with the same types of cancer. That level of collaboration between pediatric and adult centers is at its peak. It’s the highest it’s ever been, and it’s going to continue to grow. That also is a new chapter in pediatric oncology history.

How have large organizations worked on integrating these practices into standard guidelines?

The National Comprehensive Cancer Network [NCCN] is primarily one of the organizations that took the responsibility of developing evidence-based guidelines for the treatment of all types of cancer. However, until recently, [these guidelines were] mostly [focused on] adult cancers. A few years ago, there was a concerted effort to develop NCCN Guidelines for the management of pediatric cancers. Many working groups were developed, and now there are working groups across all pediatric cancers that have helped develop and establish the SOCs for how children with these cancers should be treated. These are readily accessible guidelines, and they have democratized access to the cutting-edge therapies that all children deserve to get. Similar efforts are happening in Europe and other places, as well.

In relation to Childhood Cancer Awareness Month, what are some of the most pressing unmet needs in childhood cancer survivorship that you believe deserve more attention, both in research and clinical practice?

Although we have made tremendous advances in curing the overall number of children diagnosed with cancer, there’s still more work to be done. For children who are diagnosed with a cancer where the cure rate is quite high, exceeding 80% to 90%, for example, we can rethink how we’re treating them, rethink the therapies we’re using to treat them, and consider the role of biologic therapy and how it substitutes current cytotoxic chemotherapy. That is one ongoing area of development for many cancers, such as acute lymphoblastic leukemia.

Additionally, certain cancers have not had survival increases over the past several decades, including many solid tumors, such as bone tumors, as well as muscle tumors like osteosarcoma and Ewing sarcoma. The treatments we’re using for those cancers today are essentially the same we’ve been using for the past 20 or more years. There is still a lot of work that needs to be done to improve survival outcomes for those cancers and potentially replace those toxic therapies with less toxic approaches. There is a lot of work that needs to be done there.

The other area to pursue is understanding a more holistic approach to the treatment of children with cancer and associated comorbidities. We know that the price of cancer treatment on the family and the family dynamic is high. We’re starting to recognize that there’s a high burden of financial toxicity associated with a new diagnosis of childhood cancer. Adults with cancer will [typically] think about financial toxicity, as they’re [often] not able to go to work and earn a living. However, in children, the parents are affected. Often, a parent must quit their job or cut down on their hours in a 2-parent working situation, and that has substantial psychosocial stressors for that dynamic that many researchers are working hard to address.

Finally, I would say that the broad range of issues in survivorship for the more than half million survivors of childhood cancer in the United States is a real, pressing issue. [This is] a growing population. The problems that patients are facing, by default, are also increasing exponentially. I’m proud of the work we’re doing in the survivorship community to facilitate the development of new therapies and consider our moral obligation to optimizing the health of long-term survivors. That is an active area of research, as well.

How can health care systems and advocacy groups better support survivors as they navigate life beyond cancer?

I wish I had one answer, or even a brief answer. It’s incredibly complicated. Efforts in raising awareness about these issues will go a long way for advocating for specialized resources and call attention to the relatively small demographic of children diagnosed with cancer. Thankfully, the number of children diagnosed with cancer is relatively small compared with the much larger adult population. That doesn’t mean their needs are not more pressing. In fact, I would argue that they’re much more pressing than the adult cancer needs, in part because these children have decades of life yet to be lived. The recognition of the resources it takes to treat a child with cancer can never be compromised.

Despite excellent cure rates of over 85% [in pediatric oncology], there are populations of patients who are not in that statistic. We can’t take our foot off the gas pedal and must keep the same level of intensity and energy; the health care system and the government must maintain the same level of investment. Only 4% of the government’s total cancer-related funding goes to pediatric cancers. [Patients in] this population are going to live for decades. Those dollars have potential ramifications for generations of people over the next several decades, making it important that we raise awareness. We continue to encourage additional grant and research funding for childhood cancer survivorship research and continue to push for philanthropic partnerships that will raise awareness and raise the funds we need to ask the cutting-edge questions to fundamentally improve the lives of children [with cancer].

[These efforts will] change cancer treatment today, as well as the lives of children who will unfortunately be diagnosed with cancer in the future. One day, we will cure pediatric cancer. One day, we will have survivors who are healthy without any issues whatsoever. I hope I will be around to see that, but until then, I can say that as a pediatric oncology community, we will continue to fight the fight.