Issue link: https://viewer.e-digitaledition.com/i/34195
“If I am unsure about the cause of a problem, I am clear about my concerns. I ask the family for more details and keep thinking critically about the situation. We have a responsibility as physicians to think outside the box and educate our patients.” — William Sonis, M.D., triple board-certifi ed child and adolescent psychiatrist and professor and Director of Child and Adolescent Psychiatry at the Drexel University College of Medicine signifi cant psychiatric issues. For example, if a child complains of persistent stomachaches, the problem may not lie in the gastrointestinal system. The frequent discomfort may stem from problems with schoolwork or socializing, and many physicians often respond to the symptoms with medical testing. These tests may return without comprehensive results, and medication may be prescribed to help the child with the problem. Though it may not be appar- ent on the surface, the child’s discomfort may be a manifestation of a behavioral or social problem. Approaching the problem from another perspective, according to Dr. Sonis, could clue a primary care provider into what the child actually thinks about his or her pain. Child and adolescent psychiatrists can serve as translators between a child and his or her caregivers, and many children are amazed that adults exist who actually listen and understand their concerns. “Writing a problem off without investigating further robs children of learning how to manage themselves and their problems,” says Dr. Sonis. “The child may be suffering from a larger problem — such as being bullied or struggling in academics — that can’t be solved by prescribing medication for stomachaches.” Strengthening the Battle Against Ewing’s Sarcoma Dr. Loeb has focused research efforts on finding ways to eliminate stem cells responsible for Ewing’s sarcoma tumors in children. Patients with Ewing’s sarcoma — a bone cancer occurring in children — often respond well to che- motherapy and radiation treatment, but many children relapse. Upon the tumors’ regrowth, many of these children die as a result of the disease or complications in treatment. To find a way to target tumors at their foundation, Dr. Loeb has identifi ed and studied the stem cells responsible for the regrowth. Although the research may lead to different methods of treatment if a child relapses during remission, the initial, effective treatments for Ewing’s sarcoma will most likely stay the same. “The field of oncology is moving toward development of therapies based on tumor biology rather than less specifi c factors,” says Dr. Loeb. “Current chemo- therapy and radiation treatments that target nonspecifi c cells will hopefully become more precise through study of biologic differences between cancer and normal cells.” s CHANGING THE WAY WE VIEW CHILDHOOD CANCERS LEARNING A CHILD has cancer is a heartbreaking reality, but recent research could be changing the way cancer is treated in children. Cancer is the leading disease-related cause of death for children up to age 14, but because cancer symptoms do not always appear in a typical presentation, the condition is sometimes left undetected. Pediatricians must be able to distinguish between common symptoms — such as a bruise sustained from falling off a bike — to signs of a more serious problem — bruising that signifi es a low platelet count related to leukemia. “A successful pediatrician begins a consultation assuming the symptom is related to a normal childhood problem,” says David Loeb, M.D., Ph.D., pediatric oncologist, associate professor of oncology, associate professor of pediatrics and Director of the Musculoskeletal Tumor Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “When a typical treatment pattern is followed, but the child’s results are atypical, then further testing should be performed. Trying unresponsive treatments for months without additional testing could delay the discovery of cancer.”