‘Why do child cancer patients need their own doctors’ - An overview of Pediatric oncology

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Written by Maroun Tarabey

September 22nd 2024

 

While reading The Emperor of All Maladies, I read up on the story of a young

Maria Speyer, a child in the 19th century plagued by acute lymphoblastic

leukemia (ALL). The author’s recount of the story ends with a line describing

the harrowing realities of ALL: “From its first symptom to diagnosis to death,

her galloping, relentless illness had lasted no more than three days.”1

Reading stories like these remind me of how deadly cancer is, and more

importantly, that no age group is spared — even children are affected. In

Canada, there are approximately 1000 new cases of the 12 main types of

childhood cancer each year. And yet, due to pediatric oncology, 84% of

children — i.e. any patient under 14 years old — diagnosed with cancer

survive 5 years post-diagnosis.2 Thus, it’s easy to see how important it is

as a field of medical practice.

 

This niche field of medicine bridges the worlds of complex tumour biology

and childhood physiology. With that, let’s delve into the intricate world of pediatric oncology — starting with a few common questions.

 

Information taken from statistics measured between 2015-2019 by the Public Health Agency of Canada.3

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“What is a pediatric oncologist?”

Typically found in children’s hospitals, community hospitals, and university medical departments, a pediatric oncologist is a physician who treats children and young adults after any sort of referral from a primary care physician due to a suspicion that the individual may have cancer. Typically, their responsibilities include diagnosing the patient by taking a medical history and documenting symptoms. However, they often will also perform other tests, such as urinalysis, biopsies, imaging (X-rays, MRIs, CT scans) and various blood tests to make a proper diagnosis.

 

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“What does a typical career path to becoming a pediatric oncologist look like?” 

The path to becoming a pediatric oncologist can look something like this:

• Undergraduate bachelor’s degree

• Medical school (obtain an MD)

• 4 years of pediatrics residency — the details on that can be found in our article from last week on general pediatrics!

• Specialisation: Three years in post-residency fellowship in pediatric oncology — includes laboratory work as well as clinical work.

 

“Then, what’s the difference between a pediatric oncologist and an oncologist?”

When initially planning out this article, these were my two biggest questions: “Why do we need pediatric oncologists? Aren’t cancers the same, no matter the host?” 

 

The short answer to this dilemma is that the difference lies in their approach. Children are young. Therefore, growth-inhibiting treatments, like chemotherapy, will inevitably cause lifelong effects. For instance, radiotherapy for medulloblastoma has been demonstrated to cause eventual cognitive decline through dementia.4 Therefore, pediatric oncologists are specialized in evaluating these cases carefully to maximize survival and reduce long-term side effects as much as possible.

 

This only paints half the picture, however. Since children cannot properly understand their circumstances — tending to become impatient, panicked, or uncooperative during treatment — the physician must be equipped to handle their needs. A good pediatric oncologist will be able to not only treat the child’s physical condition, but entertain them, calm them, and make them feel safe.

 

To summarize, it’s quite evident that this profession isn’t to be taken lightly. As such, I’ll end this article with the advice of an actual pediatric oncologist, Dr. Christopher T. Denny. Speaking to the UCLA David Geffen School of Medicine, he highlights three important characteristics of any pediatric oncologist: Concentration, focus, and emotional resilience.5 After all, good doctors treat disease, but the best doctors treat the person.