Childhood Cancer: The past, the present and the future

Every year, 750 Australian children are diagnosed with cancer. About one third of these children live in New South Wales, with many relying on our two cancer centres for treatment.

With modern therapies most children with cancer are cured but the treatment is very tough. The therapies are toxic and need be given over a long period of time, usually months to years. They can cause long-lasting and even permanent side effects or complications.

Despite significant improvement in cure rates though, 1 in 5 children diagnosed with cancer cannot be cured with current therapies, meaning that cancer is still the leading cause of disease-related death in Australian children.

This is our current reality but one that we, as paediatric oncologists, are working hard to change.

The teams in our two cancer centres are driven to push the boundaries to not only prevent deaths but also to find more effective and better treatments that minimise the duration, toxicity and long-term effects and give children a better quality of life.

These improvements in therapies are discovered, tested and implemented through complex, demanding research.

Research is at the centre of everything we do in patient care. It is an indispensable part of understanding the basis of cancer and finding ways to treat and prevent this disease.

Research findings drive change. It accelerates improvements in cancer outcomes and shapes what we do both now and in the future. In the last five years, our knowledge of childhood cancer has grown substantially. We now have a much deeper understanding of what really drives cancer growth and how this can vary between individual patients with the same cancer type.

Using acute leukaemia as an example, we now know that it is not one disease, but rather there are many different subtypes. Far from being an overwhelming obstacle, this knowledge allows us to work towards analysing a patient’s leukaemia in great detail, and to develop and choose the right treatment for the specific subtype of disease.

This approach is revolutionising leukaemia and lymphoma treatment. New breakthroughs in CAR-T cell therapy, which genetically modifies a patient’s own immune cells to attack their cancer cells, has already allowed the first children in NSW to be treated at the Kids Cancer Centre, Randwick (KCC). This approach will be further developed through research across both KCC and The Cancer Centre for Children, Westmead for other cancers that currently lack effective therapy.

Across the Network we have an active Clinical Trials Program that ensures that these cutting edge therapies are available for today’s children – it is central to everything we do and ensures that Australian children have access to new therapies as they are developed.

This approach also assures our patients and families that they have access to the same top-level of treatment as they would anywhere else in the world.

Right now, there are more than 200 clinical trials and research initiatives underway across our two cancer centres investigating most types of cancer. We are leading the way in CAR-T cell therapy and Immunotherapy, we are focusing more and more on personalised medicine and targeting treatment to a patient’s specific DNA, we  continue making progress with Bone Marrow Transplants finding new techniques and uses which decreases the toxicity of treatment, we are making solid progress with developments in bone and brain cancer and have started new research that looks beyond the patient to their family to identify anyone else who may be at risk of developing cancer.

Our services are expanding too. We are building Australia’s first Comprehensive Children’s Cancer Centre (CCCC) on the Randwick Health and Innovation Precinct. Together, the KCC with the Children’s Cancer Institute, will unite clinical, research and education expertise. This will accelerate discovery and innovation, speed translation and improve outcomes for children with cancer. The Cancer Centre for Children will also be further expanded as part of the Westmead Redevelopment Project and will incorporate a new vector manufacturing facility. The facility will produce the specialised gene therapy tools required to undertake targeted therapies for a range of cancers as well as other diseases.

There has never been a more exciting time or as much hope in curing cancer as there is right now. But we do need help. This cannot be done alone.

Cancer is a national health problem and relies on everyone; community, government, hospitals, research institutions and advocacy groups, coming together. Philanthropy in particular is a massive driver of discovery and success in improving cancer outcomes and in supporting children and their families. Whether it is funding new research projects and clinic trials, supporting extra educational resources for staff, supporting families under financial stress along the cancer journey or buying new equipment - these cannot happen without support from the community. The community is as much a part of this team as are our doctors, nurses, researchers, social workers and psychologists.

So the big question: where to from here? How can we reach the horizon of cure? We must get to the point where our treatments are specifically tailored for each individual patient, which are free of short-term or permanent side effects, and which cures the disease. Twenty years ago, people might have thought that this wouldn’t be possible but today, we know this is achievable.

Then the long-term aim: prevent cancer. Somewhere where we no longer talk about ‘treatment’ and improving ‘cures’; where we have changed the dialogue so we talk about how we ‘prevented’ cancer from ever occurring in children and adolescents. That’s the goal and we will all be striving hard to achieve this. 

Professor Tracey O’Brien, Head of the Kids Cancer Centre, Randwick and Dr Luciano Dalla-Pozza, Head of the Cancer Centre for Children, Westmead.

September is Childhood Cancer Awareness Month. Throughout the month, we salute the courage and strength of the children and families who have walked this challenging path and who are currently going through treatment, and we remember and acknowledge the children whose lives have been tragically taken because of cancer.