Cancer Survivorship – PediaCast 208
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Dr Laura Martin joins Dr Mike in the PediaCast Studio to discuss cancer survivorship. More kids survive than ever before, but medical care and social support don’t stop when the cancer is gone. Listen in and discover the unique life-long needs of childhood cancer survivors!
Guest
Topic
- Cancer Survivorship
Links
- Hematology, Oncology, and BMT at Nationwide Children’s Hospital
- Survivorship Care at Nationwide Children’s Hospital
- Survivorship Info from the National Cancer Institute
- Ohio Department of Insurance
- Patient Advocate Foundation
- Needy Meds
- Rx Assist
- Rx Hope
- Partnership for Prescription Assistance
Transcription
Announcer 1: This is PediaCast.
[Music]
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike!
Mike Patrick: Hello everyone, and welcome once again to PediaCast, a pediatric podcast from the good folks here at Nationwide Children’s Hospital in Columbus. It is episode 208, 2-0-8 for April 25th 2012. And we’re calling this one cancer survivorship.
Now I realize, childhood cancer is a pretty heavy topic, and it’s one we haven’t previously dealt with here on PediaCast, but we’re going to change that today. And I also know some of you out there in the audience yourself have either battled childhood cancer or you’ve lived through it as a parent, or maybe have relatives or friends who have made the journey.
01:12
Or maybe you just feared that your child would get cancer and you wonder how your family would react and cope. Or perhaps your child is a cancer survivor and you want to know what sort of long term follow-up care they need during the rest of their childhood and throughout their adult live.
Well today we are joined by Dr. Laura Martin, a pediatric cancer doctor here at Nationwide Children’s Hospital to discuss an important topic related to childhood cancer -and that is survivorship. But before we get to Dr. Martin, I want to remind you if there’s a topic that you would like us to talk about or you have a question for us, it’s easy to get a hold of me.
Just head over to PediaCast.org, and you can click on the contact link. You can also email pediacast@gmail.com,, or call the voice line at 347-404-KIDS, that’s 347-404-K-I-D-S.
02:00
I just want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.
So as always if you have a concern about your child’s health be sure to call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at PediaCast.org. All right.
So, without further ado, let’s turn our attention to our studio guest, Dr. Laura Martin is a physician with the section of hematology, oncology, and bone marrow transplant here at Nationwide Children’s. And she’s an assistant professor of pediatrics at the Ohio State University College of Medicine.
Her clinical interest include treating children with cancer with a special interest in cancer survivorship which is it turns out is what we’re discussing today. So, welcome to PediaCast Dr. Martin.
Laura Martin: Thank you very much.
Mike Patrick: Appreciate you stopping by. Why don’t we just start out with a definition. What exactly is meant by the term cancer survivorship?
03:00
Laura Martin: I think the term cancer survivorship is an emerging field in sort of reflects a new look at what our hopes and expectations are for people who have begun and completed their cancer journey as far as treatment. And the focus being on wellness beyond the end of that treatment.
Mike Patrick: Great. So this is kind of the time when the acute treatment is over, and the sort of into the remission stage, and then what kind of follow up and care do they need the rest of their lives beyond that.
Laura Martin: That’s right. What the focus really being on what do we need to be looking for and doing for them to optimize their health for many, many years beyond.
Mike Patrick: Sure. We hear the term remission a lot, so I supposed that these are kids who are in remission from their cancer. What really is meant by that term?
Laura Martin: I think it can be a little sticky to get caught up with the term remission because being cancer free is probably a better way to describe that important landmark for all our different cancer diagnosis.
04:03
Mike Patrick: Sure.
Laura Martin: Remission has traditionally referred kind of semantically more to leukemia or lymphoma, and means you’ve reached a point where the doctor’s really can’t find any evidence of that cancer anymore.
We don’t typically use that term for solid tumor, but the intent and the meaning is really the same. When someone is in remission, they’re just technically no evidence of their cancer.
That doesn’t always mean their completely finish with their treatment,it depends on the diagnosis. But it’s a step along the way to reaching what we would call -of being cured of your cancer and starting your survivorship path.
Mike Patrick: I think another term we ought to define, sort of up front that we hear a lot in cancer care and that is -what is a survival rate? So people talk about what’s the five years survival rate. What is that term? What does that mean?
Laura Martin: Five and 10 years survival rates in those can get dissected down into overall survival or disease free survival that is really more from the research world and statistical analysis of patients.
05:12
What we try to emphasize the parents is the only statistic that matters for them and to us really is how their child does, but we can give parents some expectations and understanding of the severity of their child’s disease.
The expected prognosis and our expectation for how hard it’s going to be to cure or get rid of that cancer based on large studies that tell us five year survival rates, and 10 years survival rate etcetera.
So, when you look back and say, hundreds of patients like your child were treated with this disease using this therapy, at five years this many patients were still surviving. Sometimes that’s a helpful discussion to have, and sometimes that information is not as helpful depending on how rare the disease is.
06:01
Mike Patrick: Because each individual kid’s survival rate is either going to be a 100% or zero%. And so sometimes the statistics can be a little misleading and sometimes gives parents false hope, and sometimes give more anxiety, you know, that they would otherwise need.
Laura Martin: That’s right. So when using those statistics we really treat -do try to tell parents that this is a gauge, it’s not an absolute, and it can help things.
Mike Patrick: Is cancer ever cured? I mean someone ever free from their cancer and they really don’t need any follow up and it’s a done deal.
Laura Martin: Absolutely. And I think that’s the good news especially in our field of pediatric oncology, we’re happy to say that overall to use a statistic, we really are curing approximately 80% of childhood cancers now if we would get all comers. It’s very, very different than in the early 1960s and ’70s.
Mike Patrick: That was going to be my next question is just how has cancer survivorship changed over the years and obviously it has changed for the better in a very real and great way?
07:03
What factors do you think have contributed to that change?
Laura Martin: I think one of the largest ones really has been organized large clinical trial. We belong to a consortium that’s now called the Children’s Oncology Group, you’ll hear our practitioners fondly use the acronym COG, or C.O.G.
And that arose out of some smaller consortium that have now united, but the paradigm of many centers across our country and now across the world treating large groups in cooperative trials of patients has given us the opportunity to really define and refine therapies that have been most effective. So, without doing that research in an organized and collaborative way, I’m not sure we would have made those strides.
Mike Patrick: Yeah.
Laura Martin: And certainly along the same time over decades, medical care in general has improved. Significant improvements in how we treat the complications of cancer of infectious risks, bleeding risks.
08:06
Just general health of the intensive care issues for a patients kidneys and heart, and lungs. Those have all improved as well. But I think the big jumps that we’ve seen in cure rates, in long term survival rates really have to be attributed to the cooperative efforts and clinical research trial.
Mike Patrick: And really just the trials and then the collaboration and then the dissemination of what you’ve learned from it across the network.
Laura Martin: That’s right.
Mike Patrick: Do you think too that we’re getting earlier diagnoses and maybe more specific diagnoses, does that help?
Laura Martin: Certainly more specific diagnosis and I think that earlier education and awareness across the board helps. Recognition that some cancers arise as a congenital predisposition and have a link to some genetic syndromes has been something that we’ve learned a lot about in the past several decades.
09:01
And that continues to emerge as well as the fact that the whole advent of molecular and Cytogenetic studies that we know are a large part of pediatric cancers has given us a lot of power to predict who’s going to be harder to cure and to tailor therapies to do better with those more challenging diagnosis.
Mike Patrick: Sure. Once you mentioned that you’re up to about 80% if you look at all commerce being cancer free then. What does the relapse rate really depend on? What makes the difference between the 80% and the 20%, is it the type of cancer that they have or is it just an individual’s response to treatment?
Laura Martin: A lot of factors can go on to that equation. We know that what we know now is that certain cancers are biologically more aggressive than others.
10:00
And what we also know is what we have available in our armamentarium of treatments for that. We also know that certain patients are more or less resilient or have other unrelated, underlying problems. And when you put those all together the combination of the treatment of patient receives diagnosis they have and their ability to tolerate that treatment all factor into that equation.
Mike Patrick: Sure.
Laura Martin: Sometimes patients aren’t able to get adequate treatments and sometimes the diagnosis happens very late or it’s not managed optimally in the beginning. So, those things can factor in as well.
Mike Patrick: Sure. And I would suspect that it can be difficult than to always predict who’s going to be in that so called 20% where their cancer may come back or they may get a new or different whether truly related or not cancer.
Laura Martin: That’s true
Mike Patrick: And so this is why the survivorship program is so important to sort of catch those kids who might have a recurrence of cancer, a new cancer to identify them as quickly as possible.
11:04
Laura Martin: That’s true. Probably even more of the emphasis for the survivorship clinic though is on the late effect from therapy that we’ve given them. It’s probably important to point out that entry into the survivorship program here and at many centers, it’s getting more streamline across the country.
Usually it doesn’t happen the day you finish therapy, so there’s a little bit of a window after therapy is completed. Sometimes a couple of years where close monitoring happens for just the kind of thing you’re mentioning to make sure that cancer isn’t going to come back that there’s no obvious sign of it sort of rebounding after chemotherapy.
Mike Patrick: Yup.
Laura Martin: And then once you’re in that stable phase, we make the transition to survivorship for the focus really isn’t so much on is the cancer going to come back, but what has your body sustained in response to those treatment and what do we need to do to make you as healthy as possible for your future.
Mike Patrick: Sure. What are some of the long term sort of toxic effects of cancer treatment that you’re -that folks can experience?
12:04
Laura Martin: Unfortunately we don’t have perfect therapies and I wish I could say that in 2012, we have magic bullets to take care of the cancer we want to get rid of.
So, virtually every aspect of a patient’s body is subject to side effects, but the big ones that have largest impact for us are probably neuro-cognitive or learning and brain function types of side effects that come chemotherapy and radiation. Specific side effects on the heart, cardiovascular health is a major one for some of the chemotherapy medicines that we use, and the chronologic issues.
So families care a lot about this because they can affect not only a child’s growth, but their long term fertility. And their endocrine function, there can be problems such as diabetes, being overweight. Virtually every aspect of your endocrine system and all the hormones that our bodies normally make can be all upset by chemotherapy.
13:06
Mike Patrick: Sure.
Laura Martin: Bone health and growth, skin, eyes, and everything.
Mike Patrick: Yup. So, when you have chemotherapy or radiation your goal is to destroy those cancer cells, but your normal cells are also at risk to being destroyed or modified and having problems associate with them so that’s how that occurs.
Laura Martin: That’s right. The majority of our cancer therapy is still are really directed at rapidly growing cells because that’s a feature of cancer cells that makes them susceptible to treatment. But unfortunately we have a lot of rapidly growing cells in our body so that happens as well. And then what we didn’t know initially when these things were being designed is that sometimes 10, 20, 30 years later, there can be side effects that emerged that are directly related those therapies.
Mike Patrick: And maybe we didn’t know about those side effects when we first started to use the therapy.
Laura Martin: That’s right.
14:00
Mike Patrick: We talked about the recurrence of the original cancer that that’s a fairly unusual thing to happen. What about the risk of unrelated new cancers in this patient population? Is that a concern?
Laura Martin: Overall that number if you look far out now and we haven’t looked, obviously we haven’t studied every single patient, but again the field of this research is emerging most people quoting anywhere from 8% to 10%. For most patients it’s still very low risk, but in their lifetime there’s a risk and you are that number for cancer survivors to have a second cancer. I can’t say it’s completely unrelated because we don’t know for sure that it is, but that is part of our emphasis in screening in the long term survivorship clinic.
Mike Patrick: Is there a difference between chemotherapy and radiation with regard to -because we hear radiation can cause cancer. Is that something that you see? Is radiation more likely to than result in an unrelated cancer down the road or not really?
15:00
Laura Martin: I think it depends on the chemotherapy agent you’re talking about. There are a few that are unfortunately still notorious for having that as a risk.
Mike Patrick: In addition to the radiation?
Laura Martin: Radiation does stand out though, still as an effective treatment, but unfortunately leaving a lot of side effects in its way. So, there’s an effort worldwide really to try to come up with newer therapies that could replace radiation, or limit dozes of radiation because it really does cause a lot of problems.
Mike Patrick: So we’ve talked about recurrence of cancer and the toxic effects of cancer, and so these are things that why would someone would need a survivorship program. But really cancer survivors also have a lot of long term psychological and social effects of surviving their cancer, talk about that a little bit.
Laura Martin: So, all of our patient, I mean they are on treatment, had the advantage of our multi disciplinary team that includes psychology and social work, and psychiatry if it’s needed child health sort of developmental specialist from many different angles and that need doesn’t end when they finish their therapy.
16:05
And as most of us can appreciate any family going through a cancer journey develops needs regarding that. So, siblings of patients, parents of patients, and as the family extends out those needs continue as well.
So, those are well known and still being studied as problems for cancer survivors and it’s clear that everything from issues with transition back into normal life whether it be school depending on the age of the child or venturing into the workforce, reasoning physical activity, just having self esteem issues if there has been major surgeries that we required to treat the cancer.
Some of those can be disfiguring or debilitating, we try to limit that, but still it’s a very life changing event no matter how you slice it.
17:02
And then the quote “New normal” that patients come back to have many challenges, so we need to try to address those for them in all those different levels.
Mike Patrick: I think it’s important too that parents realize -I mean, acknowledge that these anxieties and problems are there so that they do get the help that they need because there is thinking that okay, that cancer is gone you know, now let’s just get back into regular life. But it’s not that easy and, but you have to recognize it and sort of -and acknowledge that’s true in order to get the help that you need.
Laura Martin: That’s right.
Mike Patrick: In addition to the social and psychological aspects, there’s also a big financial toll that goes along with surviving cancer as well. And I always do a little bit of prep work for these interviews, and one of the things that I came across I thought was really helpful, was just the whole -how important it is not to let your health insurance lapse.
And even though now we have some healthcare reforms in place that sort of bar pre-existing conditions, but we don’t know how long that’s going to last and whether that gets overturned.
18:08
And so I mean this are all the full financial aspect of it, but still an important thing that the parents go through.
Laura Martin: It is, it’s huge. And we rely very heavily on the expertise of our social workers to help parents and patients navigate those challenges. I know there are efforts ongoing even now as we speak in Congress to try to help with that for this population, but it’s not a perfect fix yet.
Mike Patrick: Yeah. And I am going to put some -you know we’re not going to get into a lot of detail with this. I did come across some pretty good resources that I wanted to put in the show notes. If you live in Ohio, the Ohio Department of Insurance, their website has some helpful information in terms of covering and keeping your insurance up to date in pre-existing conditions and all that sort of thing.
Also the Patient Advocate Foundation , and of course you know wherever you’re located, your hospital, and hematology -oncology social workers are good sources of help in trying to navigate that.
19:06
But it’s not something you want to -I mean, you got to be proactive in figuring that out and keeping your insurance up to date. And then there’s also a lot of these things drug wise get expensive and how do parents deal with that? I mean, just in terms of the therapy, the drugs, and maybe their insurance doesn’t cover something.
Laura Martin: Again I often rely and defer to my social worker.
Mike Patrick: Sure.
Laura Martin: Colleagues because that is a huge problem and we can do our best as physicians, but you know there are resources out there, some of them come from nonprofit organizations that are targeted for specific cancer diagnosis which is a wonderful help, but those are limited.
And so, as you’re saying being proactive in getting as much of that information as possible is probably the best route about that. But it can be a huge challenge to say the least for families.
20:05
Mike Patrick: Yup.
Laura Martin: And I wish we were able to take that off their plate completely, but are still..
Mike Patrick: And especially with the economy the way that it is it seems like those kind of resources are drying up. But there are some that again in researching this I came across Needy Meds, RX Assist, RX Hope partnership for prescription assistance.
And I’m going to put links on the show note to all of those things so that folks can -I mean, it’s certainly not a guarantee that they’ll find help there, but it may be something that they would not otherwise find.
There’s also especially in really young kids have cancer, as they get older -I mean, when you’re really little you may not really understand how serious the situation is. And so as they get older then they sort of discover how serious it really was and how close they came maybe to not surviving.
And then those obviously are also fear and concerns, and anxieties that really need some time, some professional help to help them get through that. And that parents need to..
21:05
Laura Martin: Take advantage of that.
Mike Patrick: Yeah. And sort of be proactive with getting them the help they need even though they’re cancer free. How does cancer survivorship affects family planning and cancer risk in offspring?
Laura Martin: It’s a great question, and an area that’s actively still being researched. We make efforts at that time of cancer diagnosis to help preserve patient’s fertility and again that’s a very patient to patient specific kind of challenge depending on their age and the treatment they’re going to require, and the diagnosis they have.
But we’ve gotten better at that in our field over the past several years. Those options are discussed, but at that time that a patient is really more in their survivorship phase of treatment. Fertility is something that we can help patients navigate with specialists.
22:00
There are actually in the Columbus area as well. People that specialize in post oncologic kind of fertility issues for family planning and she’s about offspring. Happily we know that most cancers, most pediatric cancers are not something that a parent is going to pass on to their child if they are fortunate.
Enough to be a survivor and go on to have their children of their own. The risk to that child is really very small for a patient that received a lot of radiation or heavy dozes of chemotherapy.
Some recent studies have shown that one of the biggest risks is having babies born at low birth weight and prematurely. But now with the higher incidents of cancer, there is one caveat to that and that there is a subset of patients whose cancers really arise out of what we believe is more of a familial cancer syndrome or cancer predisposition syndrome, and that’s a separate issue.
We take advantage of having a genetics councilor in our cancer survivorship clinic to help families tease out whether that’s a concern or a risk for them.
23:05
Mike Patrick: Sure.
Laura Martin: Because that’s not something that was really appreciated probably fully even 10 years ago. So, that’s been a better approach.
Mike Patrick: In terms with the family planning, girls of course you’re kind of born with all the eggs that you have and so they’re susceptible to the cancer treating agents. But with boys, sperm is made kind of on the go. Is there a problem with sperm counts in terms of fertility ad boys who have had chemotherapy and radiation?
Laura Martin: There can be and it depends again on not just the chemotherapy, but the total dose of that chemotherapy and whether or not they had radiation and where that happened. So, strategies to try to optimize fertility include everything for boys.
Sperm donation and banking before their therapy starts and for girls we don’t were it for just sort of out the cusp and this is not the field of my expertise, but those that focus on this are really at the cusp of starting to make it viable to actually freeze eggs and have them be usable later on.
24:11
Right now what we can do is for those patients receiving radiation that would affect the ovaries, there can be a surgical procedure ahead of time to move those ovaries behind some of those organs within your abdomen to shield them and in general are you know, radiation therapy techniques have improved over several decades again to limit side scatter and toxicity direct to those organs.
Mike Patrick: Sure. Let’s kind of move on to -you have a child who has survived cancer, they’re cancer free, they’re going to start now with their survivorship program.
Talk a little bit about just how does that go along then, what sort of you know, how often do they have to be seen? What kind of test and studies do you do? What sort of goes into follow up with cancer survivorship?
25:02
Laura Martin: OK. Patients usually enter into this stream of our survivorship clinic when they’re approximately five years out from their diagnosis or two years off of therapy or both.
And we’ve started doing that a little bit earlier than was traditionally done to optimize care because it really does seem to help with the many issues families and patients have. Those visits happen just yearly, so it’s just a once a year visit, but it’s a very involved visit. We have a comprehensive clinic for most of these patients, that happens once a week.
And when the patients come they get a variety of testing done in the morning that can sometimes include radiologic studies like a CAT Scan or an echo cardiogram pulmonary function test, lab studies, those sorts of things.
And then the clinic that starts in the afternoon offers to patient visits not only with myself, and then there’s practitioner, but with the psychologist, the social worker, the nutritionist, someone from dentistry, our genetics councilor, school liaison.
26:13
And in turn each of those practitioners meets with the family in the patient to address whatever issues they might have and offer whatever services they can. So, we talk a lot with patients on those days because it is a big investment of time.
But we encourage them to keep that on their calendar for once a year visit because it really is the only time we’re seeing them now. And we are as part of the children’s oncology group updated every two years with recommendations for screening that’s specific to certain diagnosis.
And certain treatments that includes everything from what age was a child diagnose and what cumulative dose they receive of this drug or that radiation to best be screening for problems that we are just even still learning about as you mention.
27:00
Mike Patrick: And that that kind of gets us to the treatment summary and so I guess this is kind of a card with all that vital information so that if they moved and went to a new city and so now they’re going to a different survivorship program from where they were originally treated, they would have all that information,that’s an important thing.
Laura Martin: It is an important thing, and I think the value of that is still being appreciated. Many of our patients as you mentioned are treated when they’re really not the one in charge. And their parents got all the education and all the information.
And so, with our patients -as soon as they’re able to sort of participate more in that discussion we spend a lot of time educating them. And one of the things we focus on is this is your treatment summary, did you know that you received all these medications and this treatment, and why?
And And this is what you need to worry about for years ongoing. So, we like them to have that as you mentioned whether it’s our survivorship clinic or another one as part of their lifelong healthcare.
28:01
Mike Patrick: Sure.
Laura Martin: Because any physician taking care of them will need to know those things as well.
Mike Patrick: You talked about once a year, but I would imagine if they’re seeing a psychologist or the dentist, or nutritionist and there’s other things, so that the big medical screening is once a year, but they may still need more frequent follow up depending on those multi disciplinary.
Laura Martin: That’s right and worry, or happy, and able to see them as often as possible. If things are relatively problem free, that once a year visit can take care of it. But for a lot of our patients we’re still seeing them when they’re a pediatric patient, and they’re going through growth like all pediatric patients in developmental stages and transitions.
So, if something comes up they can come in more often than not. There’s also a nurse practitioner run clinic that happens weekly for those of our patients that it’s clear they really don’t need all those other facets they become to a couple of those, or they just need to come for one facet of that. So, there’s many different ways.
29:00
Mike Patrick: To go recheck or those kinds of things.
Laura Martin: Exactly.
Mike Patrick: Now, so you start that five years out from the end of your initial treatment, but this is a lifelong thing. At some point I would imagine, you stop seeing them? Being a pediatric hematologist oncologist, I mean, talk a little bit about the transition from pediatric care to adult care for these folks?
Laura Martin: This transition in terms of the care is a challenge and a relatively new field so at our program we, at this point are still seeing patients indefinitely. So, we have many patients in middle age and older that still comes to us.
We are trying to work with options to perfect the transition system,so that’s high on my list of priorities. but what we do right now to accommodate those concerns is we have a pretty substantial basis of physicians that we refer to that are comfortable taking on these patients.
30:06
What’s clear, this occurs differently anywhere you look in the country right now. And not many places have it perfected, there are a few very large centers that have tried different models.
And what is clear is that someone becomes an adult as a cancer survivor, their best option for limiting their late effects is that they be as informed as possible as their own health advocate. And that they have in their back pocket a primary care physician that’s going to be paying attention to their general health.
And some connection with the survivorship clinic whether it is you know things are so simplified that all they need is a summary of their treatment or that they are established with a clinic as well.
So, at this point we’re still exploring ways to optimize that transition. But right now we can offer patients a referral base for anything that we can if address typically.
31:05
Mike Patrick: There’s becoming more and more adult centers that have survivorship programs, is their focus mainly on adults cancers, and then the follow up for that or do they see adults who had pediatric cancers or I guess it’s probably a mix bag.
Laura Martin: The focus really is on adult cancers, and I think that’s the challenge because adult cancer doctors are experts in adult cancers and pediatric cancer doctors are experts in pediatric cancers.
And primary care physicians often have a level of discomfort with both of those, either of those. And so, the sort of three way approach I was mentioning right now is sort of the recommendation for survivors to best optimize their health because there really isn’t a perfect model in place.
I’m hoping that that would be something that is seen to have enough values that we can be developing programs like that for patients.
32:02
Mike Patrick: Sure. What’s your advice for folks who moved away from big city, so let’s say you know their job takes them to a county that’s hundreds and hundreds of miles from a large tertiary care center. The follow up care is so important for them, what do you suggest for those folks?
Laura Martin: We’ve tried to help patients in a variety of situations with that. Navigate with that same problem here,and so a lot of our college students, college aged students that moved away from Columbus we schedule their once a year visit with us even if they’re far a field from here for their studies during the summer break.
We also offer a one time consultation for any patient even if they weren’t treated here to come and sort of review and discuss their treatment summaries, they can get us their medical records, we can provide that service for them even though they weren’t our patient initially.
And I think most survivorship clinics that are established across the country, most pediatric survivorship clinics would tend to offer that as well.
33:05
They don’t have to be living in a big metropolitan area to be able to get that care because as long as they’ve had that pulled together by a team that has expertise, it can happen in pieces or at different times.
Mike Patrick: And this is one of those things too where for the most part unless something is found. We’re talking once a year.
Laura Martin: Right.
Mike Patrick: And there’s you know pediatric facilities all across the country and so you may have to drive two or three hours, but it’s once a year and it’s really worthwhile in order to make sure that you have this long term follow up.
Laura Martin: And I think that’s why we try to see the families as far as being worth that long day is in one stop or sort of trying to address any issues you might have. Recognizing that this affects every aspect of your life.
And even if we can’t fix it that day we can educate and inform patients and empower them as much possible to advocate and get the services they need.
34:05
Mike Patrick: That you talked about the one time consult kind of thing. So, if let’s say someone had leukemia and now as an adult they’re living in Columbus. So, you would see him just the one time or see him once a year or how?
Laura Martin: If they are an adult already we probably -if they are an adult survivor of a pediatric cancer, we’ve done that a couple of time where we would meet with them and go over their treatments and recreate a treatment summary and go over there if it’s not something they have.
Those patients in the past haven’t chosen to then come visit our clinic yearly, but that’s certainly an option as well. For those people that really just want to have that all summed up and sort of know what their risks are and what kind of treatment they should be receiving we provided that as sort of a consultation kind of thing.
Mike Patrick: Sure. And then that something let’s say they needed an echo cardiogram every how ever many years. I mean that’s something then that you put that sort of summary and what’s recommended they could take back to their primary doctor and then they could order those things. gotcha.
35:11
Laura Martin: That’s right. And I think the recommendation we give to people to remain connected with a survivorship clinic whether it’s our or someone else’s is just the fact that this is an area of ongoing research and we’re still actively learning. So, as I mentioned every two years those screening recommendations are changing and we want patients to have the advantage of being abreast of all those as well.
Mike Patrick: Right. And I would encourage people I’m sure there’s folks listening who are in this exact situation and maybe you haven’t even thought of about it and you think back and oh yeah, my child did have a childhood cancer and they’re not in a survivorship program right now. It’s easy to make a phone call to our survivorship program and get plugged in.
Laura Martin: That’s right.
Mike Patrick: And we’ll put a link in the show notes, the survivorship clinics and so that they know how to get in contact with you here at Nationwide Children’s.
36:02
And of course as I’ve mentioned before in the show we see folks from all over the country, so if you don’t have the survivorship program near you and you want to take a little vacation trip to Columbus, we have a great zoo, and lots of stuff to do here in Central Ohio. Well we really appreciate you stopping by and taking time out of your schedule to talk about these things.
Laura Martin: It’s my pleasure thanks so much.
Mike Patrick: Again in the show notes we’ll put a links to the survivorship clinic here at Nationwide Children’s Hospital. I also have some links to survivorship information from the National Cancer Institute and the Ohio Department of Insurance as I mentioned in the Patient Advocate Foundation.
And then Needy Meds, RX Assist, RX Hope, and partnership for prescription assistance so just check out the show notes at pediacast.org if you are interested in learning more about those things. Before you take off Dr. Martin, there’s one other thing we ask all of our guest here on PediaCast.
One of my passions is for families to do some fun things together that don’t necessarily involve TV screens. And so I think family game time is kind of -has always been sort of fun time in our house. So, we’re just kind of making a list of different games and activities that are out there.
37:08
So, just from your own experience what’s a good family game for people?
Laura Martin: We’re big on Charades, it’s not a board game.
Mike Patrick: Oh yeah.
Laura Martin: But my children are into drama.
Mike Patrick: Oh sure, yes. Do you use pre made cards or does each person just sort of pick what they’re going to do and do it?
Laura Martin: We have a few from other games actually like Trivia games and things like that. But my kids usually like to make up the topics from and we go from there.
Mike Patrick: Oh that sounds like a lot of fun. We’ve done that more than a few times in our house too. So I love that. All right. Well, once again thanks to our studio guest Dr. Laura Martin for stopping by. I also want to thank all of you for being a part of the program, we really appreciate you making PediaCast a part of your day.
Some exciting news coming up, our next episode, actually our next two episodes are going to focus on summer safety kind of stuff. 209 is the next one, we’re going to talk about pre-hospital emergency care.
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And then episode 210 is going to be a summer safety extravaganza. We’re going to talk about bicycle safety, making sure helmets fit right, and choosing the correct helmet. Swimming pool safety, playground, trampoline safety all these kinds of things. so, you definitely don’t want to miss the next two episodes where we talk about emergency care and safety issues.
Of course these are topics that are near and dear to my heart being a physician with the section of emergency medicine here at Nationwide Children’s. But it’s a good time of the year to talk about these things. I also want to remind you iTunes reviews are helpful. If you have not reviewed us on iTunes, please take the time to do so.
It really only takes a couple of minutes and a lot of people find this program and give it a try based on reviews on iTunes. So, I would appreciate that. Also links on your web pages and mentions in your blogs, on Facebook, in your tweets, and on Google+.
Also be sure to join our community by liking PediaCast on Facebook. You can follow us on Twitter, or tweet with the hash tag #Pediacast and we’re also on Google+ if you want to hang out with us there.
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Be sure to swing by the show notes at PediaCast.org to add your comments on today’s show. And we also appreciate you telling your family friends and neighbors about the program.
And don’t forget to talk us up with your child’s doctor at your next well check up or sick office visit. We have a new poster, I’ve mentioned before that we had one, we actually have two options now. So if you head over to PediaCast.org and click on the resources tab, there’s a couple of posters that you can download, printout and hang up wherever moms and dads hang out.
I also want to remind you that if there’s a topic that you would like us to talk about or you have a question for the program, just go to PediaCast.org and click on the contact link.
You can also email pediacast@gmail.com, or call the voice line at 347-404-KIDS, again that’s 347-404-K-I-D-S. And until next time. This is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!
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Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening! We’ll see you next time on PediaCast.
