Nurse practitioner Christie Chaudry knows something about comforting children with cancer.
Twenty-one years ago, she was a patient herself. Chaudry was diagnosed with acute lymphoblastic leukemia, or ALL, when she was 12 years old. She underwent three years of intensive treatment, including multiple rounds of chemotherapy.
Like about 80% of children with cancer today, she was cured.
"That was the inspiration for me going into medicine," says Chaudry, 33, who works at Stanford's Lucile Packard Children's Hospital, where her cancer was treated. "I've been very lucky."
Yet Chaudry might not have fared as well had she been diagnosed as an adult. For a variety of reasons, children are far more likely to survive cancer than adults, says Stanford pediatric oncologist Michael Link, Chaudry's former physician and current colleague.
Few adult cancer survivors dare to call themselves cured. Only two-thirds of all adult cancer patients live five years or more after diagnosis, according to the National Cancer Institute.
That has led Link and others to ask a provocative question: Could doctors improve survival rates in adults if they treated them more like children?
"Progress in the management of children with cancer is one of the great success stories of modern medicine," Link, outgoing president of the American Society of Clinical Oncology, said in a speech Saturday at its annual meeting in Chicago. "Pediatric oncology can serve as a model for the future."
Oncologists' success with children is all the more striking given that virtually every new cancer drug is designed for grown-ups, not children, says George Sledge, former president of the oncology group. Pediatric oncologists raised the cure rate for Chaudry's type of leukemia from 20% in 1970 to 90% in 2000 -- getting the most out of old drugs, most of them developed during the Cold War, by carefully testing different doses and combinations, says Sledge, a breast cancer specialist at the Indiana University Simon Cancer Center in Indianapolis.
Most critically, pediatric doctors let no child die in vain. They enrolled 50% to 80% of young patients in clinical trials, sharing their research findings with colleagues around the country, Sledge says. "Imagine if we could learn from every patient," Link said in his speech. That's not happening today. Only 3% to 4% of adult cancer patients join clinical trials, Sledge says. That makes it harder for doctors to know what's working and what's not, and to find something better.
By necessity, pediatric oncologists had to collaborate, says Stephen Sallan, a pediatric oncologist and chief of staff at Boston's Dana-Farber Cancer Institute. That's because cancer in children is mercifully rare: about 12,500 cases a year, compared with 1.5 million cases in adults.
Even at a big urban hospital, a cancer specialist might see only a handful of cases of a certain type of pediatric cancer a year, Link said.
Enrolling adults in trials is more of a challenge, Sledge says. Most adults patients are treated by community doctors who may have never participated in a clinical trial. Many insurance plans also refuse to pay for treatments provided through a trial, Sledge says.
Adult cancers also tend be more genetically complex, which makes them harder to treat, Sledge says.
Children, whose resilience is legendary, can often withstand harsh treatments and high doses that elderly or even middle-aged adults can't tolerate, Sallan says. Parents typically are devoted in caring for children with cancer, making sure they attend every appointment and take every pill on time, Sallan says. Adults rarely take equally good care of themselves.
Yet Link says he hasn't given up hope. Over the past year, the oncology group has begun to build a formal network for adult oncologists, much like the groups that children's doctors created decades ago, to make it easier for physicians to share data and learn from one another.
Link, 63, said he has been practicing long enough to have seen many of his patients grow up. He has attended their weddings. He has consulted with one, now a doctor, when the young man called to ask about tricky cases.
Saving those lives -- and giving children the chance to grow up -- makes up for the pain of treating children who can't be saved, Link says.
"These relationships are magical. These kids -- they're well until they're sick," he says. "But then, you can do something about it, and hopefully, they go on with their lives."
Chaudry hears the same call: "I feel a certain privilege to be there and be with them and share the little bits and pieces of what I learned."
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