- Pediatric cancer is the leading cause of death by disease for US children.

Tonight we focus on cancer care, including diagnosis, treatment, and support here in central Illinois.

(gentle orchestral music) (gentle orchestral music continues) Good evening, and thanks for joining us on WTVP's "Docs on Call."

I'm Mark Welp.

Last year an estimated 15,000 children in the US were diagnosed with cancer, and nearly 1700 died from the disease.

However, the mortality rate is heading in the right direction, and there are a lot of great options for treatment right here in central Illinois.

Dr.

Robert McWilliams is the Vice President and Deputy Director of the OSF Cancer Institute.

And Dr.

Brinda Mehta is the Director of OSF HealthCare Children's Hospital of Illinois Cancer & Blood Disorder Institute, and she is an associate professor at UICOMP.

Thanks both of you for coming in.

We appreciate it.

- Thank you.

- Glad to be here.

- Thank for having us.

- So let's talk a little bit about cancer in kids and how is it different from cancer maybe that we see in older adults, the elderly.

Can you kind of give us an idea of what we're looking at there?

- Yeah, absolutely.

I think cancer in kids, you know, a lot of the times it's unlike adults, where it's as a result of just our body aging and things that have been exposed to, things we may have done to ourselves.

In children, unfortunately, we have not found exact cause.

So a lot of it is just congenital reasons where a child may have a mutation that they're born with.

So it's not preventable.

It, unfortunately, just happens in children.

So there are no, what we recognize in adults as preventative etiologies.

You think, hey, don't smoke, so you don't get lung cancer.

Make sure you're eating your vegetables so you don't get colon cancer.

So there is not too many preventable cancers, and that's what makes it different from adults.

Yeah.

- And what types of cancers are most prevalent in young people, Doctor?

- Maybe pediatric oncologist is best to answer that.

- Absolutely, yeah.

So in pediatrics, the most common cancer are blood cancers, so like leukemia, so garden variety, what we call pre-B leukemia, very common in young adults.

Hodgkin lymphoma is very common.

And then brain tumors.

So if you ask a pediatric oncologist saying, "Hey, what's the most common cancer?"

Neuro-oncologist say brain tumors, it's brain tumors.

Because if you put an umbrella term, all brain tumors, if we put them all together, then brain tumors are common in children.

But if you just look like which type of blood malignancy, leukemia is most common.

Yeah.

And then, you know, sarcomas, but they're much lower, very, very rare.

- You think of the adult cancers that are common that we talk about often, breast cancer, prostate cancer, pancreatic cancer, colon cancer, they generally don't happen in children.

So the etiology is not just different, but the actual diseases and how we treat them are fundamentally different, typically.

There are some diseases that do overlap and so there's a population of patients we call adolescents and young adults who might be older for pediatric oncology and younger for adult oncology.

And there's a sort of overlap, and that's sarcoma, brain cancer and blood cancers.

But they are in general distinct.

- Yeah, so it's important that we have physicians who specialize in children and adults.

What about survival rates and how have they changed over time?

- As you know, as your introduction, I completely agree that fortunately, the mortality rates are going in the right direction, and especially for leukemia and Hodgkin lymphoma, and the cure rates are in the 80s and 90s, 90%.

So a lot of these common cancers, great success has been made over the years from dedicated scientists and researchers where we're shooting basically for cure for a lot of these common malignancies.

Now, for a lot of sarcomas, more aggressive brain tumors, it is lower, but again, the overall mortality rates and prognosis is far superior and much better these days.

Yeah.

- I would add as a takeaway from that, even though we're curing a lot of these patients, their life expectancy is still lower than the general population.

And some of that's 'cause there might be an increased risk for other cancers, could be delayed effects of treatment.

And so that's where the Cancer Institute and our Children's hospital colleagues can work together to say, as these childhood cancer survivors become adults, what particular needs do they have?

What survivorship requirements do they have?

Do we need additional monitoring for certain complications?

So that's an important partnership opportunity for us.

- Is it tougher for a child to fight cancer because they're younger and maybe they're not developed as much?

Does that have anything to do with it?

- Fortunately, kids are more resilient, so I feel like they're able to fight cancers and bounce back from things, which I was like, oh my God, this must be, you know, tough.

It looks tough.

But the next day they're bouncing around because the organ systems have not gone through life and aging and the hearts are more healthy.

So they're able to tolerate chemotherapy medications and bounce back.

And so, you know, hence they're more resilient and handle it better.

Don't you agree?

I feel like that's- - I do agree.

- Yeah.

That's why our regimens, the treatment regimen, so leukemia, the way it's handled in a child versus in an adult is so different because kids can handle some chemotherapies, whereas an adult may not be able to handle.

And it's also the reason why we undergo different training because of the way children and adults handle things and yeah.

- Interesting.

Let's talk a little bit about the Children's Hospital of Illinois Cancer & Blood Disorders Institute.

I know that you partner with a lot of different folks and bring the latest treatments to kids here in Illinois.

How important is that?

- So important.

I feel like pediatric oncology across the world has only progressed because consortiums have united and we're able to do, for a smaller population of patients with cancer, compared to adults, we have to all work together, multiple institutions have to work together, and run clinical trials together, so we can have bigger numbers to find out what is going to help our child, what's the next trial which is gonna create that impact?

So Children's Hospital, what we strive, and that's where we are part of national consortiums, so Children's Oncology Group is one of the largest consortium.

And then we also have access to CN2 clinical trials right now, and then in the future would be great through the Cancer Institute if there's access to more trials.

So we're always trying to find what's out there that we can partner with national organizations to bring more cutting edge trials and studies and collaborations to Peoria.

- Speaking of groups like that, let's talk a little bit about the Children's Oncology Group and why that's a big deal.

- So Children's Oncology Group is a national and worldwide research consortium, and it's across five different countries and one of the biggest consortiums, clinical trial consortiums in North America.

So we are a COG site.

And so basically through COG, we run multicenter clinical trials here in Peoria.

So our patients are able to stay here locally and access nationally well-vetted trials by scientific organizations and provide care over here.

- That's great.

Dr.

McWilliams, you've been here a short time.

You're very experienced, but you've been in Peoria here a short time.

You came from the Mayo Clinic.

Very impressive.

What stood out to you about the collaboration between pediatric and adult oncology programs here?

- I think there's an enormous opportunity, as OSF develops its goals of being in destination center, especially for cancer.

We have an opportunity to work together at the Children's Hospital of Illinois and the Cancer Institute are very much adjacent to each other.

We interact as specialists and we overlap in some of the specialties.

For instance, proton therapy is available in the Cancer Institute, and that can be very important for pediatric malignancies.

So the radiation dose to non-tumor tissue is much less.

And so our surgical expertise, as we develop clinical trials, there could be collaborations.

So the children's oncologists may have access to early phase clinical trials.

So it's on first in human or these really cutting edge studies.

We're also talking about collaborations on developing higher end treatments such as even bone marrow transplant or cellular therapy, what are called CAR T treatments.

So as these more complex treatments come down the pike and we have access to them, we can work together to make that happen.

And the structure of what OSF is building and what we have together in the Cancer Institute and Children's Hospital really aligns with that very much.

- Would there be a point for doctors when you're treating, let's say a teenager, an older teenager, 17, 18, where they'd be getting some treatment at Children's Hospital and then maybe transition over to the Cancer Center?

- That's a dream.

And we want that to happen, and something that Dr.

McWilliams and I have been talking about.

And we would love for that.

That would be ideal where we can transition patients, like follow them at the Children's Hospital and then, you know, transition them.

I think that is all exciting possibility.

Yeah.

- Yeah, it would be great for people to be able to stay in the area, especially and get their treatment.

And I know the Cancer Institute is already expanding even though it's not that old.

So lots of exciting things going on there.

Tell me a little bit about the services that families and patients can get, because obviously this affects a lot more than just the child with cancer.

It affects the whole family.

The Heller Center at Children's Hospital of Illinois does a lot of great things.

Tell us a little bit more about that.

- Yeah, glad you asked.

The Heller Center is a wonderful philanthropic organization and what they really help our patients with is nonmedical services.

So from exercise physiologists, counselor, dietician, and education coordinator, we have an APN, an Advanced Nurse Practitioner that's provided to us from The Heller Center, a program manager.

So if you think of all the non-medical psychosocial aspects to help the child, the young adult as a whole, so it's not just only talking about chemotherapy and what's your next lab test, what's your next echocardiogram.

We want to support the child, the young adult, the adolescent as a whole, The Heller Center helps us be that excellent collaborator and bring those non-medical services to our patient and families, just for, you know, not only cancer, but also for like blood disorders, that we care for those children as well in our clinic.

- Yeah, I think one of the things that you do very well is not only your treatments, but the atmosphere.

You know, it doesn't necessarily feel like a cold, sterile hospital.

There's a lot of smiling faces there and a lot of employees that are working together to make sure the experience is as good as it can be.

- Oh, can I ask something I only just about the Heller Center?

- Yeah.

- Is that they recently also like, you know, 'cause it's constantly expanding.

So music therapy is something that we wanted.

So I think every year, the Heller Center Medical Director Program Manager working very closely with the Heller Center, expand all those non-medical services, which we're quite excited about.

- I would say that community support, that philanthropic support is so crucial, as we think about how in the cancers too, how we care for our patients and how we provide that environment of warmth and support that patients need during really the hardest time in their lives.

We really appreciate the community support and that's really a vital part of what we're trying to bring together.

- Yep.

Can we talk about the different treatments, and I'll throw this out to both of you.

Different treatments for children and how they may differ from those same treatments in adults.

For instance, chemotherapy, radiation, immunotherapy, and kind of what parents can expect with those kind of treatments.

- So in a lot of malignancies, obviously chemotherapy, and chemotherapy, when we think about it, it's still the traditional where we have to do a lot of chemo through the port, you know, that ends up being a big backbone for a lot of cancers.

Now, if it's sarcoma, then that's when we talk about surgeries.

That's where pediatric surgeons help us out a lot.

And then if they need radiation, there's so many different types of radiation, including proton.

And so depending on each case, then we tailor it saying, okay, for leukemia, lymphoma, we tell, okay, you may not need, especially for leukemia, you may not need access to, you know, radiation.

But for someone with sarcoma brain tumor, then we'll refer them to cancer institute and the radiation oncologist there.

And immunotherapy, so that is something the public may also have heard that, is immunotherapy.

So these are newer generation drugs where we're harnessing the body's immune system and there are these very fancy molecules that use the body's immune system to fight the cancer.

So that's the new wave is immunotherapy, targeted chemotherapy, which don't have the traditional side effects of the old previous generation of oncology drugs.

So we have far more things in our armamentarium to help these young children fight the disease, and we're hoping that it will minimize a lot of longterm effects in the future.

And in the future it would be good if we can do stem cell and CAR T-cell therapy also, you know, in Peoria.

- A lot of the newest drugs show up in the adult oncology world first for various reasons.

And sometimes having that proximity, that inner working relationship we have could provide access to some drugs earlier either for clinical trials or for collaboration efforts.

So a lot of times they start in the adult oncology world and then we can steer them toward the child oncology world as well.

- Sure.

I wanna give you guys a chance to brag about your people and your facilities.

Especially, I mean, you've been all over the place.

You came from Minnesota and you've worked other places.

How special is it to have all these resources in an area the size of Peoria, Illinois?

- Absolutely.

So when I came, when I interviewed here right out of Fellowship six or eight, nine years ago, so now I'm dating myself, but that is what impressed me, Mark, and that's why I tell my team even today is when I came here, I was so pleasantly pleased with the foundation, with the team that has been built here from nurses, ancillary staff, the physicians, APN, the bones are strong, the foundation is good, OSF, my predecessor, so, you know, I have to say they've done a fantastic job in laying out a very good team for me to support and build.

It's a good group and we really believe in providing best care close to home and providing that family care.

We want this journey to be, ease it down for them as much as we can.

And so I would say, I think the medical team, the psychosocial team, philanthropic is so good in this area.

- I think for me, the impression first, when you come here from outside, you realize how strong the sense of mission is with the sisters of St.

Francis and the service to the community.

Their vision in building this destination OSF.

So it's really, yes, it's Peoria, but it's also serving central Illinois and being able to be that hub of where you used to have to travel to Chicago or St.

Louis or Iowa City, you can get that service here or we're hoping a higher level of service.

But what Dr.

Jim McGee brought proton therapy here, and that's so essential, not just for adults, but for the pediatric cancer patients as well.

The other thing that impressed me is for all the pediatric surgeries I got to tour the Jump Center where they print 3D models of the organs that they're gonna do surgery on before they do the surgery.

And so it's not uncommon where the surgeon will do that and then say, "Actually I'm gonna take a different approach than I would normally do."

And that's cutting edge.

That's not done everywhere to my knowledge.

So bringing everybody together, the experts together attracts the doctors who want to be in that environment, who want a team relationship with our care providers, who really want to have that strong community connection, and bring the best therapies to the community.

So it really has this way, once you build the culture, has this way of attracting the best and the brightest.

- Yeah.

- Oh, I'm sorry, go ahead.

- And being part of a university setting too, right?

So UICOMP is such a good academic collaborator.

So University of Illinois College of Medicine, you know, they hire all the physicians, they have a research lab.

So I think that that partnership of having OSF partner with philanthropic and having a university support makes it a perfect milieu both for research and patient care over here.

Yeah.

- It's good to know we have those cutting edge techniques and the brightest minds.

Where do you see cancer care, especially for kids, going in the future?

Where would you like to see it go?

What's on your wishlist for therapies or equipment?

What would be ideal?

- Well, ideal would be, I mean, it would be nice to continue building on the immunotherapy and targeted therapy.

Would love to continue to do that.

Being able to do, and I know Dr.

McGee and Dr.

McWilliams here, everyone's trying to do proton center clinical trials over here in Peoria.

So basically, you know, whatever's being done across the country at large institutions, we are hoping that we can sort of mimic that and continue growing.

I think we mentioned here and there CAR T-cells, bone marrow, that would be good to do that here too, if it's feasible and yeah.

- [Mark] Sure.

- I wanna make sure we have cutting edge clinical trials of a broad portfolio of trials here.

So patients have standard options for those who it doesn't work for, they need something else.

They have cutting edge therapies available here in their home area because it's so important to be close to home with the support system and the families, to be able to uproot yourself and go far away, it's very challenging and it can be very stressful for the whole family, and to be with your support system and sleeping in your own bed at night, that's just tremendously helpful for people.

- You talked a little bit about trials, and I wanna talk about that a little bit more.

How do you determine if a patient would be a good fit for a trial and kind of take us down that road, what it looks like.

- So if we have a child, like they walk through the door and we diagnose them with leukemia, then we'll see at our institution, which clinical trial is open.

And then each trial has a very strict eligibility criteria.

So now I'm going into medical terms, but it will write down saying this patient needs to have X, Y, and Z to be able to enroll on a clinical trial.

And so we make sure that we're enrolling the correct diagnosis, the correct molecular diagnosis, so that we can enroll them on the clinical trial.

And if they are not eligible, that's okay.

Then we will say, "Okay, not eligible trial, but don't worry about it.

That's not our only focus.

We still have good options, what we call based on non-clinical trials or best therapy.

So we can continue treating the child here."

And if we don't have it, common to other institutions, we could still offer the patient, say, "We don't have a trial here.

Would you like to go elsewhere?"

And that's common across all institutions is to give family that ability and choice to, if they want to, you can always go elsewhere.

But we are hoping to continue to grow our clinical trial consortium here.

- I'd say a lot of common misconception trials, it's sort of experiment you're a guinea pig and basically someone would never get less than the standard of care.

So the idea is the trials are built, that's how we improve our therapies for cancer.

And so the idea, typically it's adding something else that might work better or it's replacing a therapy with a new one that seems to be very promising and might work better.

So the goal is to add choices to someone's treatment plan and hopefully improve outcomes even more.

- Yeah, well said.

I agree.

- Would you say most parents are open to enrolling their child in a trial?

Pretty open-minded, especially when they hear the information that the doctor just said.

- Yes.

When we explain to them, we mention and specify and say that your child is not a guinea pig.

We're not taking a brand new drug directly from a Petri dish and giving it to your child.

So we do take a lot of time in these enrollment process and discussion, they can last 30, 45 minutes because we are answering every basic question to let the family know that this is not the first time ever that the drug is being tried.

Like they have gone through very rigorous, especially in pediatrics, they've gone through rigorous processes, what we call phase one, phase two, and only when it's like phase four where it can be expanded to pediatrics, that's when most of the times it's added to the clinical trial setting.

So we take the time to explain to the families, and once we explain to them what it means to go on a clinical trial, and then majority of them say yes and enroll their children on it.

- When you do treat a child for cancer, and let's say they have a tumor and you're able to get rid of it, do you have numbers on the percentages that that tumor may come back or a different kind of cancer may come back?

Is it case by case basis?

- Yeah, it is very hard to tell.

Really depends on the type of cancer, the stage of cancer, and so it is case by case.

Yeah.

- What can we tell people about the diagnosis when a family, especially parents, find out that their child has a type of cancer?

It's tough, obviously.

What can we tell them in terms of how to prepare themselves and how to move forward with getting treatment and all that?

- That discussion is obviously very heavy.

Right?

And we tell them, just by giving you that news, we have turned your world upside down, but we're here for them and we're happy no matter how many times they want us to go over the treatment or no question is a small question.

And so obviously we focus on the treatment part, but we also say that just after, I, the medical oncologist, pediatric, step out, there is a huge village of people that's gonna come here and support you from our team.

So yes, I know you're worried about the cancer treatment, but I know you're probably gonna be worried about how's my work gonna plan out and what's gonna happen to my child's school?

So we tell them, all of these questions will be answered.

There's a team that's gonna walk in and support you with all of that.

So we try our best to break it down also.

And we also have what we call new patient education.

So I, as the doctor will come and go over the treatment option, but I know there's only a fraction of what I'm telling them on day one that the family's going to remember.

'Cause it's overwhelming.

So we know that it's very important for team members to come and just go over the information again.

And then when they're getting ready for discharge, we also have the new patient education.

So we have APNs who are well-trained, who sit with like literally a binder full of new information, say, "Don't worry about it, we're gonna sit down today and for two hours we're gonna teach you top down.

So you feel fully equipped that when you take your child home, that you are like, 'Okay, I got this, but I also know who to call if I have any questions.'"

Since this group has been here for so long, we know exactly what to do and how to help the parents.

Yeah.

- And in my experience, one of the hardest times is when someone's told that they have cancer, and until we're doing something about it, that's just, you have the emotional rollercoaster and it seems like it drags on.

So one thing we do is have navigators reach out to the patients really as soon as they contact us and say, okay, start walking through the process and there's someone to ask questions of and someone to sort of, you know, virtually hold your hand as you kind of go through that and try to speed things up as much as possible.

So we don't want to delay things and sometimes the healthcare system can be really tough to navigate if you've never had to do it.

So having a guide through that experience is incredibly helpful.

- And you can help with talking about insurance and all that stuff.

- Yes.

- That is another overwhelming thing that people who are sick have to deal with.

- Yeah.

- How important is it that doctors not only have a great education, but have a good, quote unquote, bedside manner when it comes to dealing with patients and families like this?

- Well, more and more that's actually part of education.

So even now we're able to use simulation centers like the Jump Center to train people on how to have hard discussions with people.

So breaking the bad news of you've been diagnosed with cancer or transitioning treatment to so we can't cure anymore, but we can maybe extend life or even transition to hospice.

You can actually train people for the circumstances.

So even though someone may not be intuitive and be able to do that naturally, you can learn that.

A lot of that is actually learned.

And so you can learn through experience, but increasingly we're trying to move that training.

So by the time physicians are practicing in the cancer world, we're capable of doing that in a very empathetic way.

- Well, we're very fortunate to have not only great equipment and great treatments and techniques, but great people like yourselves who are trying to get rid of this awful disease.

We appreciate your time today.

- Thank you.

- Thank you very much, yeah.

- Dr.

Mehta and Dr.

McWilliams.

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