Childhood Cancer Advances, Outcomes, and Long-Term Effects With Yale's Dr. Prasanna Ananth

Prasanna Ananth, MD, MPH, is pediatric hematologist/oncologist, an associate professor of pediatrics (hematology oncology) at the Yale School of Medicine, and a leading researcher in the field of palliative care for pediatric cancer patients.

A few minutes into an episode of the radio show "Yale Cancer Answers," the guest and the host discovered that they knew and admired the same childhood cancer clinician at Dana-Farber in Boston.

Years ago, as a medical student interested in pediatrics, Prasanna Ananth, MD, MPH, recalled meeting the physician who became her mentor, Joanne Wolfe, MD, MPH, while taking a visiting elective in her final year of medical school.

“Here was a phenomenal, powerful woman, trained as a pediatric oncologist and a pediatric palliative care doctor. She founded the first palliative pediatric care program in this entire country and is also a researcher and a mom of three kids. And having met her, I was really inspired by the work she did, by her demeanor, her approach, her passion for the work—the intellectual inquiry as well as the practical aspects of pediatric palliative care research…That’s really where I derived my inspiration,” Dr. Ananth said.

"Yale Cancer Answers" host Eric Winer, MD, added his own memories of working with Wolfe at Dana-Farber Cancer Institute, describing her as “an amazing person” who founded the field of pediatric palliative care. Following is a synopsis of the rest of the radio program:

Cancer in children is rare, with approximately 16,000 diagnoses annually in the United States. It’s much higher across the globe. In the U.S., this amounts to about one in every 260 children who are diagnosed with cancer every year. The most common pediatric cancers are leukemias and lymphomas, affecting blood cells and lymph nodes, respectively. Brain tumors and solid tumors are more rare. There’s a growing understanding that most children with cancer have probably inherited some pre-disposition, but we are lacking knowledge regarding what actually causes cancer in kids. That’s a real shift from adults, whose cancers can be influenced by lifestyle choices.

Treatment for children is substantially different from treatment of adults with cancer. What is different for childhood cancer treatment is that it is very standardized, following protocols from the Children’s Oncology Group. For the most part, pretty much anywhere you go in the country, it’s likely to be virtually the same.

Leukemia in children often has an acute onset, requiring quick diagnosis and treatment. For most leukemias, the likelihood of cure is greater than 85%, with treatment lasting approximately two years. It’s a lot of visits and hospitalizations. The first six months can be very, very intensive. Yet, in the modern era of treatment, we have seen highly favorable outcomes.

Yes, targeted therapies like blinatumomab show promise for reducing toxic chemotherapy, although it's a hope for the future.

Yes, clinical trials provide standardized treatment across the country, ensuring minimal differences in treatment regardless of location.

Long-term effects can include infertility, growth challenges, learning difficulties, bone health issues, and a very low risk of second cancers. The risk of second cancers is low, less than 1% of children will have that, but that’s why it’s critical to keep follow-up appointments.

Survivorship care is interdisciplinary, with physicians, nurse practitioners, psychosocial clinicians, dieticians, cardiologists, and endocrinologists, because there is a recognition that cancer affects many aspects of health and wellbeing. Regular follow-ups even after cancer treatment are important for monitoring and managing late effects.

Cancer causes significant disruption, affecting financial stability, food and housing stability. It’s a whole-family dynamic. I went into this work because it is important to me to offer holistic care for these patients and their families. It’s what’s most challenging about my work and also the most rewarding.

I was inspired by my mentor, as I mentioned earlier, and of course by my clinical experiences. I had a number of experiences of caring for children with advanced or incurable cancers who had really difficult and contentious last weeks and months of life. There was disagreement between the care team and the family, or the patient and the family. And it made me really think about what good end-of-life care looks like. I focused my research on the gaps, where we can do better to help children with advanced cancer and their families.

Communication about prognosis and end-of-life care is challenging. It is essential for us to gently prepare and support families, enhancing their long-term bereavement process, and to involve an interdisciplinary team, including palliative care teams, in the process of communication. I really value honesty and truth-telling. There are efforts in the field of communication research to improve how oncologists communicate with families about end-of-life care.

To learn more about pediatric cancer care and Dr. Ananth, read this article.