Disability and Progress-November 11, 2024-Childhood Cancers

[00:00:00] Speaker A: KPI. [00:00:59] Speaker B: This is KFAI 90.3 FM, Minneapolis. And kfai.org this is Disability and Progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the host of this show. Charlene Dahl is my research person. Hello, Charlene. Hello. And Miguel Vargas engineers this particular episode. Erin is my podcaster. Just a couple of housekeeping things. If you'd like to be on our email list, you may email me at disabilityandprogress all written [email protected] that's disability and progressamjasmin.com we also sent out an emailer that will tell you what's coming up each week or most weeks. And so we hope you will join us today. We have a special program, as a lot of ours are. We have Dr. Lucy Turcotte, who is on to talk about childhood cancer. Hello, Dr. Turcotte. [00:02:03] Speaker A: Hello. [00:02:05] Speaker B: Thank you so much for joining us. And I was wondering if you might just start out by giving us a little history, because I noticed, like, you're not, I believe you're not originally from here. In fact, I think you had some of your schooling took place in my old stomping ground. So Washington State, maybe? Yeah. [00:02:23] Speaker A: Well, actually, I did grow up in Minnesota, right in the Roseville area, and then went away for college to the University of Notre Dame in South Bend, Indiana, came back to the University of Minnesota to do a master's in public health and maternal and child health and decided I really wanted to work with people and so went into went to medical school at the University of Minnesota and then traveled to Washington State for residency and pediatric. [00:02:53] Speaker B: That's where that came from. [00:02:55] Speaker A: Yep. So I was at Seattle Children's Hospital for three years and then returned to to Minnesota to do extra training or a fellowship in pediatric oncology and hematology at the University of Minnesota. And I've been on the faculty here since 2013. [00:03:16] Speaker B: Excellent. Well, we thank you for coming on. This is a pretty important topic. I feel like, you know, I want to start out by asking you to give us a sort of just a definition of what are some common childhood cancers and how do they differ from adult cancers? [00:03:41] Speaker A: That's a really good question. In children, the most common types of cancers that we see are leukemias, which are cancers that originate in the bone marrow and are cancers of the blood. So acute lymphoblastic leukemia is probably the most common type of cancer that we see in children. We also see see a fair number of brain tumors in children, and so those would probably be the two most common groups would be brain tumors, as well as leukemias. And, you know, how they differ from adults is really interesting. It's certainly not just the same cancer in a different size human. They behave much differently. They're biologically much differently. So when we look at them from, like, a molecular or the genetics of the cancer perspective, they often have components, completely different characteristics in kids compared to adults. And so it really changes how we approach treating them in many cases, because they do respond to treatment so much differently as well. [00:04:48] Speaker B: Ah, okay. Can you. I guess I'm wondering, what are. How many children are diagnosed with cancer each year, and are there certain types that are more prevalent than others? [00:05:06] Speaker A: Yeah, on a global level, it's actually fairly striking. There's nearly 400,000 children that are diagnosed with cancer each year. When we think about in just the United States alone, that means about 15 to 16,000 children are diagnosed with cancer each year. And so that equates to about 36 children each day in the United States. And then just to put it in a little bit more perspective, from a Minnesota perspective, we have nearly 300 children each year that are diagnosed with cancer. Certainly, that's all types of cancers combined. And so, as you mentioned, cancers that are more prevalent. Again, as we kind of mentioned a few minutes ago, the leukemias are probably the most prevalent, as are the different types of brain tumors. We also see a fair number of lymphomas, like Hodgkin lymphoma, in some of our adolescent population as well. [00:06:08] Speaker B: And do you feel like the number of children that have been diagnosed each year is that. Is that number changing from, like, let's say, 20 years ago, or is it pretty much staying the same? [00:06:23] Speaker A: It's a really good question. We have seen that there's been a steady, small increase over time in the number of children that are being diagnosed with cancer each year. And we know that in certain parts of the world, there's a number of children who have cancer that are just never diagnosed. So they will pass away before they're actually diagnosed. But in the United States, we think that we're doing a fairly good job of detecting most of these cancers. And so we don't fully understand whether there's environmental factors or other genetic factors or other things going on that are causing this gradual increase in cancer incidence in children. Children. [00:07:09] Speaker B: I'm just curious because, I mean, I had a childhood cancer, but mine was much less common. And I'm wondering, you know, what should parents watch out for? I mean, how would they even Know if their child had a childhood cancer? [00:07:29] Speaker A: Yeah, that's a great question. And, you know, as a. I'm a parent as well, and so it's something I'm always thinking about with my own kids. And it's really tricky because each cancer behaves so differently. So you think about children who might have a blood or bone marrow cancer or leukemia. They're going to present often with fatigue, you know, being very tired, bruising, bleeding. They may have fevers, but they're going to be very different from a child who maybe is presenting with a brain tumor, who might have changes in how they're walking, headaches, might have changes in their balance and coordination. And those are. Those children are going to present much differently than children who have sarcomas or bone tumors. So they may be presenting with pain or swelling, limping. So it's really tricky. There's not any one thing that I think we can tell people to watch for. I usually, when I talk about, you know, presenting with cancers, I usually just tell people if your child is acting out of the ordinary and there's something that doesn't quite seem right from a parent sense to go get them checked by their pediatrician. [00:08:50] Speaker B: Right. Which is, I mean, parents, whether they're new parents or whatever, and they wonder if they're going to do anything. Right. You kind of have an idea. You know, people grow up around people. Right. So they can have a sense of, well, maybe this isn't quite what we think should be happening. And. And there goes your idea of, like, just talk to your pediatrician about that. [00:09:14] Speaker A: Yeah. The parent gut sense is pretty amazing. I think often parents know something is wrong long before anyone else can recognize it. [00:09:23] Speaker B: Right. So let's say a child is diagnosed. Well, I guess. What are some of the steps taken once a child is suspected of having a cancer? [00:09:36] Speaker A: Yeah. So it really will depend on what type of cancer they're suspected of having. And so if the child is thought to have, like, a tumor growing in their body, whether it's like a sarcoma or a kidney tumor called Wilms tumor, or a neuroblastoma, which is another type of common childhood cancer, we often will start with getting pictures, so looking at either MRI or CT scans to better define what that tumor looks like. Similarly, if we think there might be a brain tumor, they'll usually go through an MRI of their brain to see if there's a tumor that we're able to see. If it's something like a leukemia, we typically will get a sample of their bone marrow with A sedated procedure where we actually stick a needle into their hip and get a small sample of their bone marrow to look under the microscope at the types of cells that are there. And then for things like lymphomas, where they often have small kind of masses of the lymph nod nodes, will have to do a biopsy or a surgical procedure to get a sample again to look under the microscope to do more studies on that tissue. [00:10:49] Speaker B: So I presume from, you know, over time the process has changed immensely that now there's better ways of diagnosing a cancer. And even earlier, do you find that cancers are being diagnosed earlier? [00:11:07] Speaker A: You know, I wish that I could say that I thought that cancers were being diagnosed earlier, but I don't know because they often present in such kind of unsuspecting ways. I don't know that we're diagnosing them earlier. But I would agree with you that we have much better technology now for really defining the cancers better. So the imaging that we use, like MRI and CT is much more refined than what it used to be. We have different types of imaging that is able to really look at how actively cells are dividing, which is a fairly amazing way to be able to both detect where cancer is in the body at the time of diagnosis and then follow it through treatment to see how the body is responding to treatments. I think we also have much better technology to detect disease at very low levels in the body with things like leukot leukemia, where we can look at cells down to the one in a million cells to see if there's evidence of the leukemia there. I would agree. We've seen really amazing progress in our ability to both define and detect cancers, but also to track them over time as children are getting treated. [00:12:29] Speaker B: I'd like to talk a little bit about. I feel like there's become better and better tests for markers obvious. Obviously, some childhood cancers come. You know, parents get hit and they don't even. It. It's a whirlwind. Right. They never dreamed that nobody in their family has ever had this. But some of them are genetic. Are there. Are they doing more marker testing with that idea of that? If it's genetic, they can test a baby or. Or if a child has had the cancer, can they start doing more marker certain tests then to see down the road how much likely they are to get a repeat of that or a different cancer? [00:13:18] Speaker A: Yeah, that's a good. [00:13:19] Speaker B: That makes sense. [00:13:20] Speaker A: Sorry. Yes, I think so. I'll do my best to attack it. So, you know, you're right. There's a lot of cancers that we find can be familial. And so if we do see that there are certain families that have strong histories of certain kinds of cancer, we can do that genetic testing, usually in the parents right away. And then if we see those certain mutations, we have the opportunity to test the children. Probably the more common situation in children. We know there's certain types of tumors that are associated with genetic syndromes. And so if. If children are diagnosed with some of those certain types of tumors, we'll do the genetic testing right away. The other area that you kind of alluded to is that when children are diagnosed with a second cancer, so they maybe had one type of cancer as a child and then later go on to develop a second new type of cancer, that definitely triggers that genetic testing to understand if there's something kind of in their genes that's triggering their body to develop more cancers. And that can be really helpful in developing screening protocols for those patients so that we can detect cancers earlier and hopefully identify them before they. When they're easiest to treat, at earliest stages. [00:14:52] Speaker B: Right. Dr. Turcotte, I'm wondering, how does treatment for childhood cancers differ from treatment for adult cancers? [00:15:03] Speaker A: You know, children are phenomenally strong, and I think before I ever went into this field, I would have suspected that adults would. Would get more intensive therapy or treatments for their cancer, but it's actually just the opposite. What we've found is that children are able to tolerate much more intensive therapy than adults, often because they haven't have the time or opportunity to develop other health conditions that might make their body less able to take certain types of therapies. And so when we look and compare similar types of cancers, we often will see that children get more aggressive therapies because their bodies are able to manage it better. So that's one difference. I think in adults, they're often in situations where they're living with metastatic or diseases that are kind of maybe not necessarily fully curable, but are survivable for many years, and so often are doing less intensive therapies or more targeted therapies to kind of buy them as much time and quality as possible. Where in most children, our goal is really to achieve a cure long term. [00:16:30] Speaker B: And so do you feel like the treatments that are used on children now, do you feel like that lessens their chances of secondary cancer or a repeat of the same cancer for later? [00:16:45] Speaker A: That's a great question. So we. One of my personal interests and areas of research is in second cancers, and so we used to see that we had really effective ways of treating many types of cancer with things like radiation therapy, for example. I think Hodgkin lymphomas was probably one of the cancers that we really were successfully treating and curing the earliest on. We did that by just, just blasting people with high doses of radiation, which unfortunately, in the 20 to 30 years that followed, we recognized that those individuals had really high rates of secondary breast cancers, thyroid cancers, and other types of radiation induced cancers. And so as we've started to recognize some of those, the radiation therapy and its role in second cancers and certain types of chemotherapies at high doses, and how those might contribute to second cancers, I do think we've been able to modify therapies over time, particularly in some of the types of cancers that we've had really optimal cure rates in. And we've been able to either lessen the amount of chemo or radiation that kids are getting, or add in types of targeted or immunotherapies that haven't been available in the past. Our hope is that as we continue to make those modifications, that we'll continue to reduce the risk of second cancers. Similarly, you also mentioned just relapse or having their initial cancer come back. And we think as we've been modifying treatments over time, and we kind of do this on a national level in collaboration with multiple childhood cancer treating institutions, we make small tweaks to each clinical trial that we put about, and we hope that with those changes that we continue to reduce the risk of relapse or recurrence. [00:19:03] Speaker B: I wonder at what age, you know, does. Are the. Are you. When you. When it's decided that that's no longer a childhood cancer. And what determines that? [00:19:17] Speaker A: An interesting question. Often it's more so. At the University of Minnesota, we'll treat children anywhere from birth who are. There are some children who are born with cancers all the way to young adults. So children who are young adults who are into their mid-20s, and it often is more dependent on the type of cancer that we're seeing as opposed to the age. And so there's certain cancers that are just more commonly seen in young people. And so we have more expertise in treating them and getting individuals through their treatment compared to our colleagues in the adult oncology world. So sarcomas, I think, are a really good example. Things like osteosarcoma or Ewing sarcoma are types of cancers that we'll often see in the late teens and early twenties. And although in any other sense of the Word, those are adults. Those types of cancers we tend to think of as pediatric cancers. [00:20:30] Speaker B: I wonder, what effects do cancer, childhood cancer, have on a child's, you know, both their development physically and emotionally? What do you tend to see the effects are on children? [00:20:50] Speaker A: Yeah, that's a great question. There's a whole field that's developed, really, called cancer survivorship, that has focused on understanding some of these, you know, both the physical and emotional and cognitive effects that cancer treatments can have. And just having cancer as a diagnosis can have on children as they age into adulthood. And we know that unfortunately cancer treatments can impact pretty much every part of the body. So we can see that there's these long term health consequences, or what we call late effects that affect pretty much every organ system in the body as well as kids ability to learn and thrive in school. And just as because we've modified our treatments over time to help prevent things like secondary cancers, we've also started to be much more conscious of some of these late health consequences as well as emotional and developmental consequences. And so I think we do a much better job now of screening kids and of counseling families early on about some of these possible consequences. And we actually follow these kids in our survivorship clinic many years after they've finished therapy, so that we can be looking for whether they're having any emotional or cognitive or school performance issues that might be related to their cancer therapy, as we can look and see if their lungs are working well, their heart is working well, their kidneys are working well. And again, just like with cancer, wanting to intervene as early as possible with some of these late effects, if we can intervene when they're early on or at stages that are less concerning, we can often really optimize these kids quality of life as they get older. [00:22:53] Speaker B: Having a childhood cancer, when I was young, I happened to meet somebody in school who had the same cancer. And she started growing up just one state away from me. And when we compared, I realized that her treatment was very different than mine and her outcome ended up unfortunately being very different than mine. And I realize there's a lot that goes into this, but I wonder, you know, I always wondered why her doctors chose what they chose and mine chose what they chose, which, thank goodness for me, ended up being a better outcome. So I'd like to fast forward and talk about now how doctors and families make those decisions of treatment options. Are they different and can they vary from state to state? How does that work? [00:23:51] Speaker A: Yeah, that's a great question. Our goal, and as I alluded to earlier we really do work in collaboration with other cancer centers, really across the country and across the world to help develop the best treatments possible. So to put forth clinical trials for children that we think will give them the best opportunities for long term cure. And so for most cancers, particularly the most common types of cancers, we try and really keep things as standard as possible across all children who are being treated. Now you mentioned that you had a particularly rare type of cancer. And I think that's where it becomes more challenging because there often aren't enough children even to enroll in clinical trials for some of these very rare conditions. And then as because oncologists were forced to go to the evidence that's published in literature and read through and think about what we think based on all of the evidence put together will work best for a child with some of these more rare conditions. And I think similarly, it can be really challenging when diseases or cancers recur or they come back. Then you're again forced to be thinking outside the box a little bit about what would be the next best step based on, you know, how healthy the child is, what they can tolerate, as well as how their cancer responded to their initial treatments. And so that's when I think we often will see more differences across states, across hospitals, even across doctors within the same hospital of how we approach children with certain kinds of cancer. [00:25:50] Speaker B: What happens when a child is receiving treatment with cancer? What kind of challenges do they face, like in school and things like that? [00:26:01] Speaker A: Yeah, it can be really. Yeah, it can be really tough, often depending on the type of cancer. But for many types of cancer, children are forced to take some time away from being present in person at school. And that can be really hard for, you know, socially, developmentally, to not be with their peers and not be in the classroom in those situations. The art we have great social workers on our team that help work with the school districts to get them the kind of virtual services that they need and by state law that they deserve. But it can be really challenging and often kids feel really crummy when they're going through these treatments. And so keeping up with the virtual or online schooling can be really hard because there's some weeks where they just don't have the energy or feel well enough to participate in the same way they would if they were healthy. So I think they face a lot of challenges with keeping up and with learning and with kind of proceeding at the normal rate. We'll see a lot of kids who, after they are finished with therapy, we'll end up doing a lot of kind of catch up learning or take some additional summer school courses or extra courses when they return to the classroom, of. [00:27:26] Speaker B: Course, just to kind of mark history. We are, I feel, in a more fortunate time in regards to education where we actually have the option to do some online and that child may not still feel up to as much of it that needs to be done. But 20 years ago you would have never had that. And now online is almost normal. [00:27:52] Speaker A: Yeah, absolutely right. [00:27:55] Speaker B: Yeah. [00:27:56] Speaker A: It's a much different time than it was even five years ago. Where it used to be, there were those very rare kind of online school programs that were available, but now it's so commonplace. So you're absolutely right. To get services now is much, much different. It used to be, you know, even when I started doing this, you know, 14, 15 years ago, where teachers from the district would, would come out to a family's home and do teaching, you know, in person in their home, and now it's. It's much more accessible, I think, and much easier for districts to provide the necessary services. With the changes that we've seen with, you know, the COVID pandemic and the accessibility of online or virtual school platforms. [00:28:48] Speaker B: Maybe the only positive thing that came out of COVID So true. I'm wondering, and I guess I'm especially concerned now with the change of politics and who knows how this will change, But I guess I feel like insurance and whatnot is a strain enough on families. Certainly when you get strapped with a cancer, the bills are phenomenal and phenomenally high. And insurance does not always cover everything. And as you know, some treatments can be more than others. So. So how, you know, how do families navigate that financial strain with childhood cancer treatments? And are there options open to them that they don't have to drain everything they own to have those? [00:29:52] Speaker A: Yeah, I mean, the financial piece can't be underestimated. It's really heartbreaking to see the amount of financial strain that is placed on families that are navigating any cancer diagnosis, Whether it's in their child or in themselves. You know, there's a whole area of research called, you know, in financial toxicity. Because just as you're saying, even with great insurance, there's still co pays that are, you know, coming about. Parents are still having to miss work to care for their children and so losing income, we still see that oftentimes they're needing to travel to their cancer treatment centers. And that means that may mean paying for lodging or meals away from home, Providing childcare for other children at home while they're at the hospital with their child with cancer. So there's so many pieces that can contribute to the financial piece. I think the insurance part is really challenging because I agree, we just don't know how that's going to change in the coming years. And it's been getting harder and harder to navigate, and the insurance companies have become more and more strict about what they'll approve. And we spend a huge amount of time battling with insurance companies, particularly in children, to get medications covered that we feel are appropriate. And it's often because medicines don't get approved for children until they've been tested and approved in adults often, and then they come down the pipe to children. And so we're often doing therapies that are maybe deemed experimental by insurance companies, but are deemed to be the most effective for our pediatric patients. And that can cause a huge amount of stress for families as well when they see those insurance denials come through and see us having to fight through over and over. And we're fairly tireless in our efforts. But I do worry that it will get more and more challenging. So you'd asked, I think, about kind of what resources are available? How do families navigate this? Unfortunately, there's not a lot of great resources that are standardly available, and we often rely on some of the local foundations or philanthropic support. So grants for families through local foundations are hugely helpful. I think within Minnesota, one of the organizations that I think does a really tremendous job is the Pinky Square foundation, where they can provide families with assistance for things like rent or for providing meals or lodging or things that just the logistics of life that it's hard to find other sources of funds for. So we, our social work team does a lot of work to help families identify grants that they might be eligible for and to help find any sort of financial support that might be available to them to help get them through without, as you mentioned, sort of draining all of their resources. [00:33:14] Speaker B: Right. Yeah. It can be daunting. And my hat goes off to you because I have seen doctors really fight for what they feel are the best treatments over and over again. And so I admire you guys for all that you do with those insurance companies. And I can't say thank you for everybody out there enough because that it is unfortunate that you have to even do that, but a lot of people would be lost without that. [00:33:44] Speaker A: Yeah. And I think it's so important. [00:33:49] Speaker B: What do you see that when a child gets a cancer diagnosis? What type of effect does that have on their siblings? [00:34:00] Speaker A: That's really interesting. You know, I think each family has a little bit of a different dynamic in how they approach the new diagnosis with siblings. But it can be very hard for a number of reasons. You know, as we mentioned, there are a lot of families from more rural areas where they're having to separate and have one parent and the child with cancer be near the hospital where the rest of the family maybe is. Is at home. And so their siblings are often having one of their parents that they're not seeing for many weeks at a time. And that can be really a hard thing. I think there's often also so much attention that has to be placed on the child with cancer that siblings often do feel a sense of feeling a little bit forgotten or lost when it's a challenging situation and no parent intends to do that. But because of the many issues that need to be tended to in the child with cancer, the sibling often takes a little bit of a backseat. And I think just also the fear as a sibling of not really understanding what is happening with their sibling with cancer and not necessarily understanding if they might be at risk for having something like that happen too, can be really scary. And something that we often try to help talk through with the siblings. And we do have through our child life program at the hospital, some resources for siblings where they'll have sibling specific activities for them to participate in or around times of diagnosis. We'll do some special activities with siblings to help them understand more about their siblings cancer diagnosis and how hopefully alleviate some of the fears and unknowns that they might have. [00:36:04] Speaker B: And what role do organizations like American Childhood Cancer Organization play in supporting affected families? [00:36:14] Speaker A: Yeah, I think organizations like American Childhood Cancer Organization are really powerful in providing a lot of different means of support for families. So I think there's just the. There's, as we mentioned, kind of just the philanthropic or financial support that can be hugely beneficial. There's the education. So providing resources for families, resources for the community, that is really powerful. Oftentimes these organizations are also really active in policy, and so helping lobby for policies that will help support children and families who are dealing with cancer is really important. And then often they're also engaged in helping to support research. So I think in many different ways, organizations are really active in kind of supporting families from multiple different angles. [00:37:16] Speaker B: I'm wondering if you feel like childhood cancer survivors are at risk for more health conditions later, more so than people who didn't have a childhood cancer? [00:37:33] Speaker A: Absolutely. Unfortunately, we haven't gotten to the point where we've been able to take away those late effects or those long term chronic health conditions that come as a result of the cancer therapies that we give. And so we do see that. It's this sort of idea of what we call accelerated aging where we see that our survivors, even though they might be in their 30s, tend to have a health that is more similar to someone in their 50s or 60s. So they are having, they're getting cardiovascular disease earlier, they're getting type 2 diabetes earlier, they're experiencing all of these health conditions that we don't tend to think of in young adults or in middle aged adults, adults, but they're occurring younger than we expect. And those are often as a result of the treatments that we give to them as children. [00:38:34] Speaker B: Right. It makes me scared just thinking about it with adult cancers, that presumably, you know, people who get adult cancers, they have the same thought, right. That they'll have more health stuff later because of the treatments. [00:38:52] Speaker A: Absolutely. And adults are in a challenging boat because they often come into their cancer diagnosis already with some chronic conditions, so it can make it even harder to treat them and then are even more likely to develop other conditions. [00:39:11] Speaker B: You know, when adults go through cancer and they come out the other side, there's often a big push on how are you going to live the rest of your life? Meaning how much exercise are you going to do now? Are you going to really be regiment about getting your exercise in? Are you going to keep a diet that is a healthful or good diet, or in the case where maybe you didn't have a good healthy diet, are you going to acquire one? Is this true as well for childhood cancers? Or is it not necessarily as big. [00:39:49] Speaker A: Of a deal feel, you know, it's incredibly important. I, I think we counsel all of our survivors on the importance of exercise, healthy diet, healthy lifestyle, you know, not taking on things like smoking and drinking and vaping. And similar to adults are survivors of childhood cancer. You know, all take a slightly different approach to the decisions that they make and the health, the healthy practices that they decide to adop or not. So it's, you know, certainly is, I would say, just as important, if not more important, because they've got potentially many more years of life ahead of them. But it is, it's challenging just to, you know, to try and convince people sometimes of doing the right things for their health. [00:40:45] Speaker B: You know, I've really spent a lot of time on children with childhood cancer, but I don't want to miss the parents and caregivers because they are a huge deal in this. How does having a child with childhood Cancer affect that you've seen affect parents and caregivers? [00:41:06] Speaker A: I think it has a really significant impact on parents and on their mental health and on just their whole outlook on being a parent and caregiver. You know, we really do attempt to support families in every way that we can, particularly for parents. But I don't think enough can be said for the long lasting impact that going through childhood cancer as a parent or caregiver can have. You know, I think often children will go through it. And for the youngest one, they might not remember their childhood cancer diagnosis or treatment, but their parents do. And I think many of them have long lasting memories and challenges and probably some PTSD that goes along with going through cancer with a child. And so we're always very encouraging and supportive of helping parents and caregivers find emotional and mental health support. [00:42:15] Speaker B: And what are some of the misconceptions that you have found out there that people are thinking about childhood cancers? [00:42:26] Speaker A: That's a really good question. You know, I think maybe not a misconception, but I think there's a lot of fear about treat, you know, childhood cancer treatments, things like chemotherapy are very scary for families and for, you know, certainly in people who are maybe a little bit wary of the medical field and of standard medicine, find that the treatments that we are often recommending can be very hard for people to accept. So I think that can be a real challenge. I also think one of the maybe misconceptions that families come into is thinking that their child is going to feel so horrible throughout all of their treatment and it's going to be just awful. And what I think has been, what's really amazing watching children go through treatment is how resilient they are. And really seeing kids often thrive through their treatment, where they're continuing to meet their developmental milestones, do amazing things, still able to thrive despite going through challenging treatments. And for many families, that ends up being a bit of a relief, especially for some of the longer therapy courses where they see that they're up against two years of treatments and they, they're worried that it's going to be a few years of really just horrible hard times. [00:44:08] Speaker B: Right. I'm aware of how somewhat of how clinical trials can work with adults and cancers and sometimes they can be really hard to get into just at the right times to find. I'm wondering, are there clinical trials for childhood cancers and, and do they work the same or is it easier for children to get into that? [00:44:37] Speaker A: Yeah, for the most common types of childhood cancers, we typically do have available Clinical trials. So things like acute lymphoblastic leukemia or acute myeloid leukemia or Hodgkin lymphoma, or many of the brain tumor types, we often do have available clinical trials, and they're large enough that they are accessible to any child or family that wants to participate. I think once we get into some of the. So individuals who maybe have relapsed or have cancers that aren't responding well to their initial therapies, some of those early phase trials where they're, as you're mentioning, just taking one or two participants at a time, or there's only certain slots available at certain times, those can be more challenging. But those are often the really early phase drugs that we're trying to get data on to see if they're going to be successful enough to bring into some of the larger types of trials. But I would say, in general, for pediatric patients, we do make every effort to make clinical trials available to families if they're interested. And for most childhood cancer treatment centers, they're offering a full array of clinical trials to interested families. [00:46:11] Speaker B: I want to just make sure I ask my research person, Charlene, is there any questions you have for Dr. Turcotte? You guys have covered almost everything. I had to think of Dr. Turcotte. I think, you know, when people go through cancer, be it a child or adult, it feels like the unknown is scary. Right. So I feel like I see people with maybe good intentions, and we all know what good intentions do, but they wish people well, but then they kind of hide away from. And they don't. They don't always go see that person as much as they should. Can you suggest how the community can help support children with cancer and their family? Families, yeah. [00:47:17] Speaker A: You know, I think just showing up, being present, sending the email or text message, even if it's just a quick, we're thinking about you, we're, you know, sending our love. You know, one of the things that I know the kids and families often really love are getting, you know, they'll come to the hospital and bring cards that their child. Child's class had made and put them up in the room. And it's a really beautiful reminder for the child of the support that they have from their classmates or from their peers. You know, I think other things that I've seen that have been really meaningful are just, you know, sending meals or, you know, sending. Offering to pay for someone to come and clean their house for them. I mean, things that just. They don't have time for or paying for delivery Services like you just don't have time for, often doing the things that you normally would do for your family when you're going through this. And so I think just finding ways to show up and show that you care, even if you don't know what to say, just saying, thinking about you today can go a really long way for people to not feel so isolated and alone. [00:48:35] Speaker B: And I think what people don't think about always, if they've never had to address cancer or had anybody very close to them who's gotten cancer, is that be it child or adult, I feel like this runs the same. And you. There are going to be always good days and bad days. And believe me, the person scrolls through those emails and texts and letters and rereads and rereads them on the bad days because that's what keeps them afloat. Wouldn't you agree? [00:49:09] Speaker A: Oh, absolutely. I think those kind messages, the cards, the pictures, those. Those can really help lift people up on hard days. I think, you know, when you take maybe the sibling to do something special so that the parent doesn't feel the guilt of not being able to do something, those can be just really powerful gestures that can help people through really, really, really dark times. [00:49:38] Speaker B: How can we increase awareness of funding for childhood cancer research? [00:49:43] Speaker A: Oh, gosh, it's so important. You know, every year I go out to D.C. and try and lobby for, you know, more, more funding for the work that we do. As a researcher and a physician, I, I feel so strongly about it. So I think writing letters, talking to our government officials, it's going to be a challenging time, I think, going forward in the next four years. And I hope that people continue to be vocal about the things that matter to them and about the things that matter for children and for children's health. But the most important things we can all do are just using our voices, using our votes, using all of those things to continue to do our best to make a difference, difference. [00:50:33] Speaker B: Dr. Turcotte, thank you so much for coming on. You are amazing and people like you are what makes this show go. And I really do appreciate the time that you've spent as volunteer to do this show. So thank you. [00:50:50] Speaker A: Thank you so much for having me. And it's always a pleasure when people are highlighting the work that we're doing and the. This amazing group of children who are going through cancer. So thank you for highlighting this today. [00:51:05] Speaker B: Thank you so much. The views expressed on the show are not necessarily those of KFAI or its board of directors. This is KFAI 90.3 FM, Minneapolis and KFAI.org you're listening to Disability and Progress. Lubin Speaking, speaking with Dr. Lucy Turcotte about childhood cancer. Charlene Dahl is my PR research person. Miguel engineered this program. Erin is my podcaster. If you want to be a part of this show or email list, you can email me at disabilityandprogressamjasmin.com I'm Sam. Jasmine. Thanks for listening.