Michael P. Link, MD: Pediatric and Young Adult Oncology Advances ASCO 2011
Michael P. Link, MD, is the Lydia J. Lee Professor of Pediatric Cancer and Chief of the Division of Pediatric Hematology/Oncology at Stanford University School of Medicine, and Director of the Bass Center for Cancer and Blood Diseases at the Lucile Salter Packard Children’s Hospital at Stanford. Dr. Link gives an update on pediatric and young adult oncology at ASCO 2011.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
VIDEO TRANSCRIPT
Selma R. Schimmel, Founder & CEO, Vital Options International
This is Selma Schimmel at the 46th annual meeting of the American Society of Clinical Oncology. And I am sitting with President Elect, incoming President of ASCO, Dr. Michael Link. Hello, Dr. Link.
Michael P. Link, MD, Lydia J. Lee Prof. of Pediatric Hematology/Oncology, Stanford University
Hi, how are you?
Selma R. Schimmel:
Let’s then take a moment to talk about some of the presentations, the abstracts in the young adult, the pediatric, the adolescent arena being presented at this meeting that are most compelling to you.
Michael P. Link:
Well, first of all, although I’m not yet president, but 2 out of the 5 plenary session abstracts relate to pediatrics. So that’s, in a sense, telling you that we have an impact in the society even though we are a very small minority of the membership. But one of the key abstracts that will be presented at the plenary session relates to high risk leukemia, which is predominantly a disease of older children, adolescents and young adults. And this is where we have a blurring of what is a patient who is an adult and what is a patient who really falls into the pediatric age group.
What we discovered from this randomized trial was that just a change in an old friend drug, methotrexate, and how it’s administered led to a significant improvement in outcome for this group of high risk children. Now there are several implications of this, and in order to really emphasize the downstream effects of this we’ve actually asked a medical oncologist, an expert in taking care of adults with leukemia to discuss the important ramifications of this study. Because it’s clear we need to make sure this gets to the medical oncology community who takes care of these older adolescents and young adults.
So, the first thing is that what we learn from children really can apply to young adults as well, that’s very important. There’s some- we also know that there’s some interesting information on the treatment of this adolescent and young adult group with various tumors, but particularly with leukemia, where we know from north American studies, studies in Europe, studies in Scandinavian countries that, and a study in France as well, that the outcome for this age group of 15 to 25 with leukemia, if they’re treated in pediatric centers they do substantially better- almost 30% better than if they’re taken care of by our medical oncology colleagues. Now, we don’t know the reasons, there are several conflicting theories.
I don’t really believe it’s because we know how to treat leukemia better, although some of it may have to do with our reliance on biology and tailoring the treatment for each patient, but part of it has to do with just our philosophy of care. We are, we don’t take Christmas off, is one of my, as Dr. Schiffer, one of my favorite medical oncologists said. We are very intensive, we keep the treatment… we are not concerned about what is going to happen in the next year for this patient, we are concerned what is going to happen 10 years from now. Our whole focus is on that this is a speed bump in their life and we’re interested in the long term survival of the patient. And if they miss this Christmas it’s because we want to have them have all their future Christmases, and that’s how we treat these patients.
Selma R. Schimmel:
When you’re at a pediatric center or an adolescent center you have a full spectrum of care, from psychosocial to the clinical, and that’s imperative for that age group.
Michael P. Link:
Well the two- now you’re actually focusing on the other elements of the care of an adolescent and young adult with cancer. So, the first focus is really on just curing the patient; that is obviously our primary focus. There are then though, bells and whistles, which we think are critically important in this age group who are in a transformative stage of their life, becoming adults, where we need to cater to their other needs. This is reintegration into school, as you say, we have to be concerned about their future concerns, their fertility, body image, social, psychosocial adjustment to becoming a survivor of cancer. And these, I think, are done very well in pediatric centers. And this is the kind of thing that we need to make sure takes place in all centers that are taking care of this age group.
Selma R. Schimmel:
Let’s take a moment to talk about, and I believe there was an abstract regarding the whole survivorship issue and the translation of information with, between the pediatric and the young adult patient and the community based physician. There are some gaps there that we need to address.
Michael P. Link:
This is a key problem. Interestingly, one of my first opportunities as the president elect of ASCO was in appointing committee chairs I discovered that ASCO did not have a survivorship committee. It had a subcommittee but it didn’t really have a huge focus on this. And when we think about how many of our patients, including adult survivors, including women with breast cancers where we have many, many survivors, and yet we didn’t have a focus for these patients both in terms of their medical problems, in terms of the legislative and regulatory issues relating to these people that are- these are the patients that we, or the survivors that we have created.
So, we know that there is a lot of expertise in the medical oncology community and we have learned, of course, a lot about survivorship from the management of children with cancer because for a long time we’ve had survivors. We’ve been curing cancer in children much more regularly and for a longer period of time.
What are some of the problems? Well, pediatricians don’t see much cancer in their career, so when they refer a patient to a pediatric center we take over their care, we take care of some of the psychosocial issues and also their survivorship issues. But then they have to, when they’ve survived, we have to transfer their care back to their physicians. Many of these children that are 4 and 5 years old when they’re diagnosed don’t even know what they had, and so we have to inform them of what they have, what are the medical consequences of their therapy, what are the concerns that they should have about their future medical issues; and these are things that they have to take with them and we have to develop better ways of doing it.
Selma R. Schimmel:
This is where I believe that we need to encourage parents, as we move into the electronic health records and electronic patient records on the consumer end, that parents, for the sake of what’s coming ahead would be best to begin to document and maintain their pediatric, and their adolescent, their children’s medical records so when those kids become young adults they can be handed all of that information electronically. And you’re smiling.
Michael P. Link:
I’m smiling because I don’t know if the parents are… I’m a parent and I have 2 girls, and I’m not sure that we’re going to be the most effective people to do this. But somebody has to do it and we have to do it, the physicians taking care of these patients. And what we have to do is provide them, with either a passport or some sort of summary of what they had and then to be able, as you say, to be able to hand their doctor their medical record on a memory stick to be able to know, with advice of how should, what should you be looking for in this patient who is now a survivor because of the specific therapy that they had received. So, I’m a big believer in parenting but not parenting adolescents, so I’m not sure that they are going to take our advice. But we are working on mechanisms now to be able to deliver to the patient, when they’re old enough, all of the information that they will need take with them and with their increased mobility, they have to be able to take it with them wherever they go.
Selma R. Schimmel:
Dr. Michael Link; President Elect of the American Society of Clinical Oncology, ASCO for this year, starting 2011. You are also Lydia J. Lee Professor of Pediatric Oncology at Stanford University, School of Medicine. Privilege to talk to you. Thank you, thank you so much.
Michael P. Link:
Thank you. It was my pleasure.
Selma R. Schimmel:
Congratulations.
END OF VIDEO